Get Mt Wic Infant Formula Request Form 2021-2025

This guide provides clear and supportive instructions for users on how to complete the MT WIC Infant Formula Request Form online. By following these steps, users can ensure their requests are accurate and complete, facilitating the approval process.

Follow the steps to complete the MT WIC Infant Formula Request Form:

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred digital editor.
2. In Section A, Participant Information, enter the participant's name, date of birth, and today's date accurately to ensure proper identification.
3. Proceed to Section B to specify the length of time for which the formula is requested. Select one of the options provided, such as 'Until end of certification,' 'Until first birthday,' or specify other dates if needed.
4. In Section C, Medical Formulas/Nutritional Products, denote the prescribed amount of formula. Choose between 'Maximum Allowable' or enter the specific amount each day. Provide a brief description of the infant formula requested, ensuring to check the relevant diagnosis boxes.
5. If additional formulas are needed, list them in the designated section with justification if applicable. This includes outlining any additional dietary needs.
6. Complete Section D with the healthcare provider's information, including their name, signature, and phone number, to validate the request.
7. Review the entire form for accuracy. Once satisfied with the information provided, save the changes, download, print, or share the completed form as necessary.

Take the first step towards securing the needed formula by filling out the MT WIC Infant Formula Request Form online today.