Dietary Questionnaire and Guidance


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The Kansas WIC Program uses diet questionnaires to assess the dietary/feeding practices of WIC applicants. This enables WIC staff to assign applicable risk factors and determine appropriate referrals, counseling and food package tailoring needs. All WIC applicants complete an age and categorically appropriate Diet Questionnaire at certification.

WIC clinics should copy Diet Questionnaires using the following color guide:

Prenatal - Yellow paper
Postpartum - Blue paper
Young Infant (0-6 months) - Green paper
Toddler (6-24 months) - Purple paper
Child (2-5 years) - Orange or Peach paper

The guidance documents review the risk factors that are assessed by each question on the corresponding Diet Questionnaire. Refer to the Nutritional Risk Factor manual for the complete definition for each risk factor.

Click on the links below to download diet questionaire and guidance materials

Prenatal

Prenatal Diet Questionnaire

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Prenatal Diet Questionnaire (spanish)

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Prenatal Guidance


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Postpartum

Postpartum Diet Questionnaire

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Postpartum Diet Questionnaire (spanish)

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Postpartum Guidance


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Young Infant

Young Infant Diet Questionnaire

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Young Infant Diet Questionnaire (spanish)

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Young Infant Guidance


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Toddler

Toddler Diet Questionnaire

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Toddler Diet Questionnaire (spanish)

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Toddler Guidance


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Child

Child Diet Questionnaire

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Child Diet Questionnaire (spanish)

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Child Guidance


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