Employer Services Request

Before you fill out the form, please make sure you have this information:

  • Contact Person Info
  • Business Legal Address
  • Location for Service Address (if different from legal address)
  • Services you would like us to provide
  • Estimated Number of Participants
  • Your preference: do you want us to visit on-site or provide vouchers
  • If onsite: Preferred Dates & On-site Coordinator contact information
  • If Vouchers: activation and end dates
  • Payment preference: Invoice or Third-Party Insurance
*Answers can be changed once contacted by the Kroger Health team.
Get Started