Stamford Mikvah Appointment Reservation

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User this form to request a mikvah appointment

Your Name *

Your Email Address *

Your request *

Required Questions

We continue to screen requests to make an appointment. As per our medical advisors, all out of town guests are required to take an antigen test on the day of your appointment and show it at the appointment. If you do not have one, you can purchase one at the mikvah for an additional $10 fee. If you are purchasing one from the mikvah, you will need to come 15 minutes prior to your appointment.

Have you had any of the following symptoms in the last 5 days? Fever, cough, shortness of breath, runny nose, sore throat, muscle pain, chills, recent loss of taste or smell. *

Yes

During the last 5 days have you had close contact with anyone with Covid-19 or with any of the above symptoms? *

Yes

Have you traveled internationally within the last 10 days? *

Yes

Do you reside outside of Fairfield County, CT? *

Yes

Are you vaccinated? *

Yes

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This form was created inside of Stamford Mikvah.