Report a WIC Shopping Problem

This form is for Women, Infants, and Children (WIC) participants in Dane County, Wisconsin. To report a problem using your WIC benefits to buy eligible items, please use this form or email wic@publichealthmdc.com. Our staff will contact you to discuss the problem further.

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Contact Information

Name

May we contact you by phone to discuss this problem further?

Yes, call me by phone

No, contact me another way

We can also contact you by email. Please enter your email address.

Phone

Problem Information

Name of Store

Location of Store (City)

Date

Time (Approximate)

What items were you not able to buy with your WIC benefits?

Did you use another form of payment for the items?

Yes

Attachments

You can attach pictures of the items and your receipt. Please make sure the items barcode is visible.
Maximum 3 files. 10 MB limit. Allowed types: jpg, jpeg, png, pdf, doc, docs, xls, xlsx.

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Report a WIC Shopping Problem

Women, Infants & Children (WIC) Program

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