Instacart Accommodation Request Form
To request an accommodation for a medical condition or disability, please complete this form. Even if you have requested the accommodation verbally, we ask that you follow that verbal request with completion and submission of this form.
If you need assistance with making an accommodation request or completing this form contact your manager or
I need or would like assistance with submitting this request.
Date you first requested the accommodation:
If you are a shopper, list "shopper" here
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