The WIC Program provides services to pregnant women, new mothers, infants, and children up to five years of age who are at nutritional risk. Services are based on medical and income eligibility. The primary services provided are:
Please visit the State of Missouri WIC website for information on income eligibility guidelines.
Forms and Documents
If you are an existing or prospective WIC client, save yourself time by printing and completing the appropriate forms and diet sheets below before visiting our office:
WIC Medicaid Release Form
Nutrition Assessment for Women
Nutrition Assessment for Infants
Nutrition Assessment for Children Ages 1-5
Evaluación de Nutrición Para Mujeres
Evaluación de Nutrición Para Bebes
Evaluación de Nutrición Para Niños de 1-5 Años
If your child has a medical condition that requires the use of special formula and conventional foods are precluded, restricted, and inadequate to meet his or her special nutritional needs, please ask your Medical Provider to complete the following form:
Medical Documentation - Health Care Provider Authorization
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.
Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.
To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or
(833) 256-1665 or (202) 690-7442; or
This institution is an equal opportunity provider.