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 *
Cell Phone Number *
Your answer
Name *
Your answer
Date (7 Days after Hefsek Tahara) *
Appointment Type *
Appointment Length *
Time Request. Please write ideal time frame after nightfall. Please specify if there is a time block that does NOT work for you. (For example 8:00 - 9:00pm not before 7:00pm) *
Your answer
Payment. $25/Taharat Hamishpacha. $54/Bride. $36 Taharat Hamishpacha plus Mikvah Donation. *
Comments and Questions
Your answer
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