Formula 
Prescriptions

Formula 
Prescriptions

Formula 
Prescriptions

 

To meet the medical needs of your patients

 

WIC health partners should fill out the Medical Request for Formula form to request WIC formulas for their patients. Once completed, fax the form to your patient’s local WIC clinic, or print it for the patient to bring to the clinic.  

Local WIC clinical staff have to review all medical requests for formula, which are subject to approval based on WIC state agency policy and federal regulations.

Please carefully review the instructions and forms before completing them. Health partners are encouraged to call their local WIC clinic or state agency WIC staff if they have any questions about the formula prescription process or forms. 

Visit Infant Feeding Options for more information about WIC formulas and the criteria for their use in the WIC program.

Know your infant feeding options.

Texas WIC Formulary

Download the latest Texas WIC formulary (PDF, 377KB)

Disclaimer: Product descriptions and details may vary over time.  Please check with the manufacturer for the most up to date information about the products listed here.

Medical Request Forms & Instructions

Texas WIC Medical Request for Formula/Food
(English) F13-06-13152 (PDF, 152KB)
Texas WIC Medical Request for Metabolic Formula
(English) EF13-06-13158 (PDF, 325KB)
Instructions for Medical Request Form for Metabolic Formula
(English) EF13-06-13158-1 (PDF, 122KB)
How do I mix my baby's formula?
(English) 13-06-12255 (PDF, 876KB)
How do I mix my baby's formula?
(Spanish)13-06-12255a (PDF, 953KB)