Rukyah Form

We offer in-person Rukya services ONLY after you have you have performed Ruqya on yourself. Please confirm you have done so before submitting this form: *

Instruction on how to perform ruqya on yourself and your home: https://mcceastbay.org/self-ruqya

Your Name *

First

Last

Your Email *

Your Phone *

This issue is happening with:

What is this person's relationship to you? *

What city do you live in? *

MCC East Bay is a regional organization primarily serving the 90,000 Muslim communities in Alameda and Contra Costa counties.

When did this first start happening? *

What were the circumstances in which this started happening? *

Severity when this started happening

Selected Value: 1

1 is mild and 10 is severe

Describe in detail what happened *

What, if any, treatment have you sought? *

Current severity

Selected Value: 1

1 is mild and 10 is severe

How do you feel we can help you? *

How would you describe your current relationship to God?

How many times a day do you pray? *

Fee for services *

Employed Person - $100 to $150
Student - $50 to $75
Requesting for service fee to be waived (please note why in comments below)

The Shaykh is volunteering his time outside his normal responsibilities to perform this service. Please consider compensating him for his time.

Additional questions or comments? (optional)