Clinic forms

All files on this page are Adobe Reader PDF format unless otherwise noted.

Materials available on this page:

Looking for review tools? These are now located on the WIC Coordinator page.

Looking for breast pump forms? These are now located on the Breastfeeding Resources page.

Participant notification forms

Participant signature form (57-629)

Large print available online only: Participant Signature (front): English
Large print available online only: Participant Signature back (Voter Registration): English

Rights and responsibilities (57-630)

What proof to bring to WIC (57-632)

Oregon Secretary of State voter registration forms and information (links to an external site)
SEL 503: Voter Registration Form: English | Spanish
SEL 500LP: Large Print Voter Registration Form: English

All assessment forms available only online or in TWIST

Infant Certification 0-12 months (57-602): English
Infant Certification Mandatory Questions (57-602a): English
Child Certification 13-60 months (57-601): English
Child Certification Mandatory Questions (57-601a): English
Pregnancy Certification (57-618): English
Pregnancy Certification Mandatory Questions (57-618a): English
Postpartum Certification (57-619): English
Postpartum Certification Mandatory Questions (57-619a): English
Postpartum Certification Fetal Loss (57-621): English
Postpartum Certification Fetal Loss Mandatory Questions (57-621a): English
Request to Collect Hemoglobin Blood Test Values (57-682) Fillable PDF
Lead Screening Referral Form: (Half Page) English | Spanish (Full Page) English/Spanish

Growth charts are available online or in TWIST only

Notice: Change in your WIC benefits (available online or in TWIST only) (57-608):
English | Spanish | Arabic | Burmese | Chinese | Chuukese | Dari | Karen | Nepali | Pashto | Russian | Somali | Ukrainian | Vietnamese

Replacement of Unavailable/Stolen Formula (57-912): English (Word) | Spanish (Word)
3 Ways to Stay Connected to WIC (fillable PDF): English/Spanish
Mailing eWIC Card Letter (fillable PDF): English | Spanish

Common WIC foods (visual teaching tool, available online only): English
Shopping with eWIC (self-paced lesson, available online only): English | Spanish
I couldn't buy it with eWIC! (available online only): English/Spanish
Troubleshooting eWIC shopping issues (staff reference sheet)
Shopping with eWIC page for participants: English | Spanish
eWIC shopping videos (via the Oregon WIC YouTube channel)
WIC Shopper app (how to install and use): English

Shopping with your eWIC card (57-1002)

Using your Oregon eWIC card (57-1008)