WIC 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.
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) 5 years old or younger
Submit
Should be Empty: