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.

* indicates required fields

Contact Information

Name *

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

Yes, call me by phone

No, contact me another way

Phone *

Email *

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

Problem Information

Name of Store *

Location of Store (City) *

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. Allowed file types: jpg, jpeg, png, pdf, doc, docs, xls, and xlsx. Maximum file size: 10 MB.

File 1

More information

Files must be less than 10 MB.
Allowed file types: jpg jpeg png pdf doc docx xls xlsx.

File 2

More information

Files must be less than 10 MB.
Allowed file types: jpg jpeg png pdf doc docx xls xlsx.

File 3

More information

Files must be less than 10 MB.
Allowed file types: jpg jpeg png pdf doc docx xls xlsx.

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WIC Program

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