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Are You Pregnant? Apply for WIC!

Did you know you are eligible for WIC if you are pregnant?

You do not have to wait for your first prenatal visit at your doctor's office.  As soon as you know you are pregnant you can apply to receive benefits for yourself.   Fill out the form below and click Submit.  We will contact you to set up an appointment!

WIC Application

Are you pregnant?  Complete and submit this form and we will contact with you to schedule an appointment so you can start receiving your benefits.

Do you have any children under the age of 5?

Thanks for submitting. We will be in touch with you soon!

Meriden WIC Pregnancy Application

Women, Infants, Children (WIC) Program

5. Is this person Hispanic or Latino?
6. Race (Check all that apply)

Health History

11. Have you been pregnant before?
14. Check any problems with previous pregnancies
15. Check any problems you are having with this pregnancy
19. Do you have a dentist?
20. Do you crave eating any of the following:

Cigarette, Alcohol, Drug Use

21. Do you currently smoke cigarettes, pipes, or cigars?
22. Did you smoke in the 3 months before this pregnancy?
23. Do you live with anyone who smokes in your home or around you?
24. Did you drink in the 3 months before this prgnancy?
25. Do you currently drink alcohol during pregnancy?
26. Check any other substances you are using during this pregnancy.

Nutrition Information

27. How has your appetite been during your pregnancy?