WIC - Request Appointment
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Last Name * (Parent/Caregiver or Guardian)
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If yes, due date

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#1 Child's Name
Date of Birth Please enter month and year of birth, mm/yyyy
Gender
#2 Child's Name
Date of Birth Please enter month and year of birth, mm/yyyy
Gender
#3 Child's Name
Date of Birth Please enter month and year of birth, mm/yyyy
Gender
Primary Language of the Family
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Haverhill: (Main Northern Essex WIC Office)
(978) 374-2191
Community Action, Inc.
145 Essex Street
Haverhill, MA 01832
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& Fri: 9am - 5pm | Tues:
10:30am - 6:30pm | One
Saturday per month:
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