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 hr@instacart.com.
Date you first requested the accommodation:
Your answer
Name:
Your answer
Phone Number:
Your answer
Position:
Your answer
Manager's Name:
Your answer
City/Region
Your answer
Team/Dept.
If you are a shopper, list "shopper" here
Your answer
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