Strengthening Partnerships and Referrals between Perinatal and Pediatric Providers and Local WIC Agencies

Estimated Survey Time: 1 minute

Local WIC agencies are interested in being a referral partner with you!

Please share how they can best connect with your practice/organization.

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* 1. Practice/Organization:

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* 2. Counties Served:

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* 3. Do you already have referral contact(s) for all of your service area's local WIC agencies?
Listing of Local Agencies Providing WIC Services

Yes

No

Unsure

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* 4. If a local WIC agency were to contact your practice/organization to initiate a referral partnership, who would be the best person for them to contact first?

Office Manager

Head of Staff

Other (Title)

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* 5. How would your practice/organization prefer to be contacted by local WIC agencies?

Email

Telephone

Stop in at office