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WIC Appointment Form

  1. PERSONAL INFORMATION

  2. My mailing address is the same as my home address.

  3. Please select your communication prference.

  4. FAMILY INFORMATION

  5. Do you have children under the age of 5?

  6. Are you currently pregnant?

  7. APPOINTMENT INFORMATION

  8. Please select your preferred appointment times at your preferred location.

  9. West Allis

  10. Greenfield

  11. Cudahy

  12. Click "submit" below to complete your request.

    A member of our staff will review your information, check available times, and contact you shortly to schedule your appointment.

  13. Leave This Blank:

  14. This field is not part of the form submission.