You may request a copy of your patient's nutrition assessment by checking the box for this purpose on the Medical Referral Form. Be advised that WIC can release participant information only with written consent from the participant.
Should you experience any difficulties in receiving the information, please let WIC know by calling the Senior Nutritionist at your WIC Office Locations in Massachusetts or the WIC Health and Human Service Coordinator at (617) 624-6100.
- Medical Referral Form for Women and Infants (PDF 2MB)
file size 1MB
file size 1MB
- Medical Referral Form for Infants and Children (PDF 2MB)
file size 3MB
- WIC Office Locations in Massachusetts
This information is provided by the Women, Infants and Children (WIC) Nutrition Program within the Department of Public Health .