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
• Alternate Contract Formula HCP Letter
  

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.