WIC Pre-Enrollment Form
Please submit the following form to begin the enrollment process for WIC. Once submitted, a Flathead City-County Health Department WIC staff member will reach out to you. This form is secure.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Please check any of the following that apply to you:
*
I am pregnant
I am breastfeeding
I recently gave birth (postpartum)
I have an infant (or infants)
I have a child (or children) younger than 5 years of age
For enrollment we will need proof of ID, proof of all household income, and proof of current residency. If you have documents proving ID, household income, and/or current residency, you can upload them here. This form is secure. If you do not have these documents available right now, we will collect them from you later in the enrollment process.
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