Skip to main content

Health and Diet Questionnaires


Health and Diet Questionnaires 

  • Form numbers and titles are: 

DCH 1314- Pregnant Woman 

DCH 1315 Postpartum Woman 

DCH 1316 Postpartum for Miscarriage

DCH 1317- WIC Infant Health and Diet Questions (Birth to 1 year of age)

DCH 1318 WIC Infant Mid-Cert

DCH 1319 WIC Child 

Medical conditions and Illnesses - Laminated, rev 2/18