Referral for Services at Roots Community Health Center
Refer yourself, a patient, or client to services at Roots Community Health Center.
Please enter the following information about the person who needs the services
Preferred Roots Site
Roots Main in Oakland (Adult Clinic & Social Services)
Roots Pediatric Clinic in Oakland (Pediatric Clinic, Ages 0-18)
Dream Youth Clinic (Youth Clinic, Ages 13-18)
Covenant House in Oakland (Youth Clinic, Ages 18-24)
Roots South Bay in San Jose (Adult Clinic, Limited Social Services)
If medical services aren't needed, please skip this section. To request a specific program, please enter the program name under "Other."
Medical Services Requested (check all that apply)
Primary Care Doctor/Nurse Practitioner
Family Planning/STD Testing
Hepatitis C Treatment
High Blood Pressure (Hypertension) Care
Medication Assisted Therapy (suboxone)
Mental Health - Medication Management
Mental Health Counseling
Do They Have Health Insurance?
If social services aren't needed, please skip this section. To request a specific program, please enter the program name under "Other."
Social Services Requested
Health Insurance or PCP change to Roots
GED/High School Diploma
College Degree/Trade Certificate
Social Security Card
Please enter the following information about the person making this referral
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This form was created inside of Roots Community Health Center.