Our mission is to prevent disease, assure a healthful environment, prolong life, and promote well being for the citizens of Medina County.
Promote, Protect and Prevent
Local Calls: 330-723-9688
1-888-723-9688
4800 Ledgewood Drive, Medina, OH 44256

Forms

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Before competing any of these forms, first contact our office to schedule a WIC appointment. We will then let you know which of the following can be completed before you arrive.

Welcome to WIC letter

WIC only Application

WIC only Application (Spanish)

Health History for Pregnant Women

Health History for Post Partum/Breastfeeding Women

Health History for Infants (Birth to 1 year of age)

Health History for Children (Age 1-5)

If you are not able to be present at your child's WIC eligibility appointment, you may have an authorized representative act on your behalf by completing the following letter. Please call the WIC office at 330-723-9688 option 4 for other paperwork that may need to be completed if an authorized representative will be bringing your child to their WIC appointment.

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