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Grocery Delivery Assistance Application

1. Have you had a brain injury?
Yes
No
2. Are you the primary caregiver for a person who has had a brain injury?
Yes
No
3. Do you live in one of the following regions:
Northern Kentucky
Cincinnati
Southeastern Indiana
4. Please select one of the following that most closely resembles your situation:
Driving to the grocery store and obtaining the groceries presents a hardship. Having the groceries delivered to my door would help reduce the hardship.
I am able to drive to the grocery store and shop for my own groceries. I can load my own groceries into and out of my car or have someone do it for me.
5. Would you or a caregiver be able to use the Kroger app to order groceries?
Yes
No
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