Mikvah Appointment Request
Please fill out this form and allow 24 hours for a response. We will try our best to accommodate your needs regarding time. Please keep in mind that our volunteer attendants may have prior commitments and it may be necessary to be flexible regarding timing.
Email address *
Name *
Phone Number *
Date you need appointment (7 days after you completed the Hefsek Taharah) *
Ideal Time Frame After Nightfall (For example, 7: -8: pm. Not later than 9:00 pm) *
What is this appointment for: *
What type of appointment do you need: *
Payment: *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy