Request an Immersion

Please fill out the form below to request an appointment at Mayyim Hayyim. If you are requesting an appointment for more than one person, please select "Add another response" at the bottom of the form; you must use a unique email for each adult.

Contact Information of Person Immersing

I am filling this form out on behalf of a child (under 18)

YesNo

First name

Last name

Date of Birth of person immersing

Gender

Pronouns

Parent/Guardian First Name if under 18

Parent/Guardian Last Name

Email of parent/guardian

Email of person immersing

Phone

Address

City

State

Postal Code

Country

Immersion Information

Please request your appointment at least two (2) business days in advance. Although not always possible, we will do our best to accommodate other requests.

When submitting a request, you can expect:

Your increased flexibility within the posted hours and requesting appointments farther in advance will yield a higher likelihood of confirming your appointment.
An email from our staff to either confirm your requested time or suggest alternative options.

Hours of operation:

Monday - Thursday: 10:00am - 9:00pm
Friday: 10:00am - 3:00pm
Sunday: 10:00am - 5:00pm

Please note that evening hours are reserved for women or those practicing niddah.

When would you like to immerse? Please share three dates/times in order of preference:

First Choice Date and Time

Format: 8/1/2022 1:00pm; please exclude any extra spaces or characters

Yes, I am flexible by 15 minutes before or after this time choice.

This is the only time I am available; no need to offer other optionsI have some flexibility and can offer other options

Second Choice Date and Time

Format: 8/1/2022 2:00pm; please exclude any extra spaces or characters

Yes, I am flexible by 15 minutes before or after this time choice.

Third Choice Date and Time

Format: 8/2/2022 11:00am; please exclude any extra spaces or characters

Yes, I am flexible by 15 minutes before or after this time choice.

I will prepare at home and only need a 30 minute appointment: Please check here if you are sensitive to heat and want to prepare before arriving while our ACs are in repair OR simply want to help with appointment availability and enable increased accessibility for others

Anything else you would like us to know about your availability?

Reason for Immersion

Other

Preferred gender (if any) of Mikveh Guide:

During your visit, a volunteer Mikveh Guide will always be present to welcome you and ensure your privacy. Traditionally, a Mikveh Guide acts as a witness to make certain that one’s entire body (including all hair) is immersed under water. Mikveh Guides hold a sheet above their eyes, only lowering it down at the moment of immersion. Mayyim Hayyim also trains Mikveh Guides to help facilitate the ritual, providing guidance and support when appropriate. However, you may choose to immerse in private or with a friend or family member acting as your witness.

Yes, I would like my Mikveh Guide to wear a face mask.

If you expect to bring any guests with you, please let us know about how many (up to 10) you expect to join:

Is there anything else you'd like us to know to help make this experience as meaningful as possible?

Please select the reason that most closely describes what prompted your decision to request this immersion

Contact Information