For Healthcare Providers

If you would like to refer a patient to the WIC Program or request a therapeutic formula, please use the form(s) below:

• TN WIC Referral Form (PH-3151)
  
• Tennessee's Nutrition Related Qualifying Conditions
• Fillable Request for WIC Eligible Therapeutics (PH-4077)
• Tennessee WIC Program Formulary

The WIC supplemental foods that are offered to participants are aligned with the Dietary Guidelines for Americans and the American Academy of Pediatrics’ infant feeding guidance.