Quarantine Delivery Request (Middlesex)
Please use this form to submit a request for assistance for you or someone else in Middlesex. Volunteers in Middlesex have agreed to bring you the goods/groceries you need!

If you have questions about COVID-19, dial 211. If you feel ill, contact your health care provider by phone. If you recently returned from Europe, the United Kingdom, Ireland, China, Iran or South Korea, call the Health Department: (802) 863-7240. For questions about Middlesex emergency management, call the Town Clerk at (802) 223-5915.

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Name: *
Address for delivery: *
Phone (if none, enter "none") *
Email address:
Method of payment (check, cash): *
Do you require anything from a specific store? If so, please list the brand or product and store.
Please list all goods/groceries you'd like delivered. We will strive to provide all that you list, but begin with what you feel is most needed. *
Are there any specific brand products you require, for which you will NOT accept substitutes?
Is there anything else you would like your courier to know?
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