Baby'S Diet Health Questionnaire Form - Wic Oregon Page 2

6. If your baby drinks formula:

a. What formula do you use?

b. What type do you use?

 P owder

 C oncentrate

 R eady-to-use

c. How are you preparing the formula?

d. How much formula does your baby drink each day?

7. How can you tell when your baby is hungry or full?

8. What is your plan for introducing infant cereal and baby foods to your baby?

9. What is your plan for introducing finger foods to your baby?

10. What is your plan for introducing the cup?

11. How do you handle and store expressed breast milk or left over formula?

12. Is your baby receiving a Vitamin D supplement?

 Y es, has a supplement or drinks one quart of formula or milk per day

 N o

 Unknown

13. If your baby is 6 months or older, is he or she receiving fluoride?

 Y es

 M y baby is not 6 months old yet

 U nknown

 No

For alternate format requests, please call 971-673-0040. TTY 1-800-735-2900

WIC is an equal opportunity program and employer.

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