JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Summit County WIC Nutrition Education
Please complete your nutrition education before your WIC card load appointment.
Remember to submit your response at the end!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
List the last 8 digits on your WIC card
*
Your answer
Who is on WIC?
*
If more than one applies you may choose to complete the form more than once.
I am pregnant
Baby 6 months to 12 months
Child 12 months to 5 years
Postpartum
Nächste
Clear form
Never submit passwords through Google Forms.
This form was created inside of Summit County Public Health.
Report Abuse
Forms
