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Complaint Against WIC Participant

Complaint Against WIC Participant

  • Witness Contact Information

    Your name and at least ONE contact method is needed for the State Office to be able to follow up on this complaint. If 'anonymous' is selected, we will not share your name with the Clinic.
  • Complaint Type

  • Complaint Information

  • Date Format: MM slash DD slash YYYY
  • :
  • What happened?

  • This field is for validation purposes and should be left unchanged.