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WIC Signup Request Form

WIC, or the Special Supplemental Nutrition Program for Women, Infants and Children, is a nutrition program funded by the United States Department of Agriculture. WIC is available to pregnant, breastfeeding and postpartum women, infants and children up to age five. To submit a request for WIC services, call 910-893-7570 or or use this form.

Please fill out the form below to submit your WIC signup request. A WIC representative will contact you within 3 business days to complete the process. Spaces marked with an asterisk (*) are required for proper processing. Your request will be forwarded to: 2023 Harnett County (Health Department).

Last Name *
First Name *
Phone *
Best Time to Call *
Referred By
Validation *