Southern NEK Quarantine Delivery Request
Please use this form to submit a request for delivery for yourself or someone who may not have access to google forms.

If you’re symptomatic, please call your Primary Care Provider.

For a Northern NEK/Newport Region help request please visit this link: https://docs.google.com/forms/d/e/1FAIpQLSdfiroMPTZzPTgCFA9dbzN4biKzX_jnwMnpMnSliMHwk1ap6g/viewform

Are you feeling ill? Find yourself stuck at home, needing something from the outside world? We're here to help!

Volunteers in and around the Kingdom have agreed to bring you the goods/groceries you need!

Here's a continually updated list of St. Johnsbury delivery & carry out and grocers services: https://docs.google.com/spreadsheets/d/1gz_YKc2zkC9AtNKrsI679a7URQUDdTPWfakGP2pKOIU/edit?usp=sharing

Fill out the form below - we'll be in touch quickly.

For resources available to Vermonter's call 211or check out the collaborative Covid-19 resource document:
https://docs.google.com/document/d/17DJMyLZR_Fk7MzaCD9AU0O8a61VGVvoeNs4qbVk0z3E/edit?usp=sharing

For any questions about this form, volunteering, or a delivery request, please call or text Megan at 530-320-7704
Name: *
Your answer
Address for Delivery: *
Your answer
Phone (if none please enter n/a): *
Your answer
Email Address (if none please enter n/a): *
Your answer
The White Market offers online/phone ordering and pick up. If this is possible for you to do, please order goods this way for sake of efficiency, that said we are not affiliated with the White Market in any way. Can you do this? If so please respond to this as other with your order information including order # and name it will be under. *
Do you need medicine/prescription drugs picked up? Once we have a courier for you we will be in touch with their name and info and you can contact the pharmacy to arrange pick up. *
For all non-White Market orders see below:
Do you require anything from a specific store? If so, please list the brand or product and store.
Your answer
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.
Your answer
Are there any specific brand products you require, for which you will NOT accept substitutes?
Your answer
Form of Payment for other non White Market orders (check, cash, Venmo, PayPal, etc...):
Your answer
Would you be interested in receiving herbal support in the form of tea/tincture? This can range from helping with stress, supporting your immune system, helping with dry cough and much more. These will be offered at sliding scale cost simply to cover for materials, not to make a profit. Herbal medicine is not intended to cure or treat, simply to support the body in times of illness. If so, we will be in touch!
If you are feeling isolated and in need of connection, are you interested in volunteer offered peer-to-peer support via phone or online platform?
Is there anything else you would like your courier to know?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy