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Click ‘Get Form’ to open the Florida WIC Program Medical Referral Form in our editor.
Begin by checking the eligibility for Healthy Start. Mark 'Yes' or 'No' as applicable.
Fill in the client’s name and birth date. Optionally, include their sex, address, phone number, city, zip code, and social security number.
Complete the relevant section based on the client's category: Pregnant Women, Breastfeeding Women, Infants and Children under 24 months, or Children aged 2 to 5 years. Ensure all measurements are taken within the specified time frame.
Check any identified health problems and specify if nutrition counseling is requested.
Sign and date the form at the bottom. Include your office stamp for validation.
Provide this completed form to the client or parent/guardian for their WIC appointment.
Start using our platform today to easily fill out your Florida WIC form online for free!
Yes, WIC eligible items can be shipped to you when using your WIC benefits.
What is the maximum income to qualify for WIC in Florida?
WIC Income Guidelines Household Size*WIC Income Eligibility Based on Income Intervals AnnualWeekly 1 $28,953 $557 2 $39,128 $753 3 $49,303 $9496 more rows Jul 24, 2025
What does WIC in Florida provide?
WIC is a federally funded nutrition program for women, infants, and children. WIC provides the following at no cost: healthy foods, nutrition education and counseling, breastfeeding support, and referrals for health care and community services.
What is the income limit for WIC in Florida?
WIC Income Guidelines Household Size*WIC Income Eligibility Based on Income Intervals AnnualMonthly 1 $28,953 $2,413 2 $39,128 $3,261 3 $49,303 $4,1096 more rows Jul 24, 2025
What documents do you need for WIC in Florida?
You must be currently living in Florida, but you dont have to be a U.S. citizen. ONE proof of identification (ID) for you and ONE proof of ID for any infant or child applying for WIC, such as a birth certificate, drivers license, crib card, military ID, photo ID, Social Security card, or hospital record.
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Women, Infants, and Children (WIC) referrals: . Provide a completed Florida WIC program medical referral form with the current height or length and weight
Women, Infant, and Children (WIC) Food Nutritional Guide
Bring ONE proof of identification for you and ONE proof of identification for any infant or child applying for WIC, such as a birth certificate, drivers
By completing this form, you are indicating that a diagnosed qualifying medical condition necessitates the use of a different formula(s) from the current
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