Breastfeeding forms

WIC Forms and Publications

The following forms used by local WIC projects are available in PDF and Word-fillable formats.

BREASTFEEDING

Title	Number	Format
Breast Pump Order Request (Revised 02/11)	F-40052A	Word-fillable
Breast Pump Release Form English (08/08)	DPH 40105	Word-fillable
Breast Pump Release Form Hmong (08/08)	DPH 40105H	Word-fillable
Breast Pump Release Form Spanish (08/08)	DPH 40105S	Word-fillable

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Last Revised: March 28, 2011