Please pre-register BEFORE 8:30 am on the day you wish to be tested. If it is after 8:30 am on the day you would like to be tested, please just come to the site and we will register you there. Please do NOT pre-register after 8:30 on the day you want to get tested. 
Also note: Oakland registrations over 30 days old will be deleted, San Jose Registrations after one week will be deleted,  so please re-register before your test date if needed.
See you soon!

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* 2. Are you a Roots patient?
Note: Roots patients are welcome to walk up, but may also call to schedule a drive-up testing appointment at:
- Roots Headquarters (7272 MacArthur Blvd. Oakland, tel. 510.533.1248), or
- Roots South Bay (1898 The Alameda, San Jose, tel. 408.490.4710)

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* 3. What is your last name? 

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* 4. What is your first name?

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* 5. What is your Date of Birth? 

Date

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* 6. What is your Social Security Number? (optional - we're only asking in the event it may make us eligible for financial relief for this program in the future)

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* 7. What is your Phone Number? [Type in numbers with no punctuaton. Include area code]

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* 8. How else can we reach you?

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* 9. Are you unsheltered / homeless?

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