WIC (Women, Infants, n Children) Supplemental Program

Woman Infant and Children Supplemental Food Program

Improvement Form
We need your help to improve WIC. Please check all the answers that apply to you and your family:
County Name :	Site:

Who is currently receiving WIC checks in your family?
Infant under 1 year child 1 to 5 years pregnant woman breastfeeding woman postpartum woman(not breastfeeding)
How long have you or your family been on the WIC Program?
today is my first visit less than 6 months 6 months to 1 year 1 to 2 years more than 2 years
I think that the services I receive at WIC are:
excellent good average fair poor
The one thing I like most about WIC is:

The one thing I do not like most about WIC is:

If I could change something about WIC it would be:

If I have a problem picking up my WIC checks it is because:
I have no transportation
I can't come during WIC office hours because of a job, school, etc.
I forget my appointment
I have a problem with child care.
other
Are you treated fairly and courteously by the WIC staff?
always most of the time sometimes not very often never
The WIC staff are easy to reach by telephone.
always usually very hard to reach (I frequently get answering machines or busy signals)
The usual waiting time to pick up my WIC checks is about:
5 minutes 10 minutes 15 minutes 1/2 hour or more
During the last 6 months, I have talked to a nutritionist at the WIC office about my or my family's nutrition or food needs.
yes no
The WIC nutritionist or other staff providing nutrition information:
listened to my nutrition concerns
gave me good, practical ideas
confused me with too much information
did not provide useful information. Why?
Why?
The nutrition information I received helped me or my family to:
eat a healthy diet while I was pregnant
breast feed my baby
feed my baby or child
understand normal eating habits of children
understand how to read food labels
decide to breast feed
drink more milk and eat more dairy foods
eat foods high in iron
eat 5 or more servings of fruits and vegetables most days
drink more water and less sweetened drinks
save money at the grocery store
keep my family healthy
use healthy snacks
use WIC foods in cooking
plan simple and quick meals
Other
I like to learn about nutrition by:
talking with a nutritionist, nurse or doctor
talking with other WIC staff
talking with another mother who has breastfed her baby
talking with my friends about nutrition
looking at a video film
reading a newsletter
reading nutrition posters
reading a pamphlet
attending a class on nutrition
solving a word puzzle about nutrition
I would like to learn more about:
saving money at the grocery store
how to read food labels
choosing or buying foods to stay healthy
feeding my baby and/or child
using WIC foods
breastfeeding
good health habits
having a healthy baby
planning simple and quick meals
food safety and storage.
Other
If you ever missed picking up your WIC checks for a month or longer, what were the reasons?
I didn't have transportation
my appointment was not at a good time
I was not in town
I forgot my appointment
I lost my WIC ID card
I didn't need all the food or formula
I didn't like coming to the WIC office
I couldn't get off from work
I was embarrassed to use my WIC checks
my family did not want me to get WIC checks
there was not enough food on the checks for me to come in and get them
other reasons
Answer the following questions only if you breast fed or are breastfeeding your baby
In the first week after delivery, did someone from WIC help you with breastfeeding?
yes no
If yes, where or how did you receive this help?
by telephone at the hospital at the WIC office at my home
Is there anything you would have liked to learn more about:
why breastfeeding is good for baby/mother
how to get off to a good start at the hospital
how to prevent sore nipples
how to have good milk supply
how to go to work or school and keep breastfeeding
how to contact someone with breastfeeding questions
Other