Brit Milah Check List
1. Your full Name:
2. Your address:
3. Your e-mail address:
4. Your spouse’s e-mail address and cell number:
5. Your home and cell numbers:
6. The date and time of the baby's birth:
7. If the baby has not arrived, when is your due date?
8. Is this your first child?
9. What are the names and ages of your other children?
10. Are you having a scheduled/elective cesarean section?
11. Has the sex of the baby been confirmed by sonogram?
12. When is the scheduled date of delivery?
13. Were you on any “ blood thinners” such as: Heparin or Lovinox during this pregnancy?
14. Were you treated for a coagulopathy disorder during this pregnancy?
15. Baby's full English name:
16. Baby's Hebrew name:
17. Father's full English name and date of birth:
18. Father's Hebrew name:
19. Mother's full English name and date of birth:
20. Mother's Hebrew name:
21. Sandak's name:
22. Sandak's relationship to the baby:
23. Kvatter/Kvatterin: This is the person/people who brings the baby in the room. It is usually the mother and father..
24. What are the names of the baby’s grandparents, great-grandparents and step-grandparents who will be attending the ceremony?
25. Will a Rabbi be present?
26. Who will cut the Challah and say the Motsi?
27. What is his relationship to the baby?
28. The names of two (2) witnesses for the Bris certificate: It should be noted that if the mother of the baby is not Jewish, then the witnesses should be an Adult Jewish person who is not a blood relative of the baby..
29. The telephone number of your pharmacy: This is required so that a prescription for EMLA Cream (topical anesthetic) may be called into your pharmacy. This cream should be applied 1 hr. before the actual start time of the ceremony.
30. Name and complete address of where the Bris will take place:
31. The e-mail address and telephone number of the family/friend hosting the Bris:
32. Does the Bris street and town address differ from the GPS address?
33. Date and time of the Bris:
34. Actual time that the Bris is to begin:
35. Whom may we thank for referring you to this site?
36. What is their e-mail address?
37. Please send the completed Brit Checklist to Dr. Roberts so he may review it prior to the Bris.
It would be my honor to attend your son’s Brit Milah.
Dr. Richard I. Roberts - Certifed Mohel