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California cities and communities served by South Los Angeles Health Projects WIC : South Los Angeles, Bell, Bell Gardens, Compton, Cudahy, Downey, Huntington Park, Lynwood, Maywood, Paramount, South Gate, Vernon

Please complete this form. A WIC representative will contact you soon. She or he will answer all your questions.

Your first name (required)*
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Phone number with area code (required)*
Please enter all 10 numbers:
xxx-xxx-xxxx
What kind of phone is this?
- A cell phone
- A landline
A second phone number with area code
Please enter all 10 numbers:
xxx-xxx-xxxx
What kind of phone is this?
- A cell phone
- A landline
Address
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Email address
What is the best way to reach you?
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- By landline
What is the best time to reach you?
- 8:00 a.m. - noon (morning)
- noon - 4 p.m. (afternoon)
- 4 p.m. - 8 p.m. (evening)
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Do you have questions about this form? Phone (310) 661-3080.