THE NAME CHANGE TOOL KIT
[ MEDICAL ORGANIZATIONS (medical plan, dental, physician, etc.) ]
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OFFICIAL FORM(S) REQUIRED:
• Notice of Name Change Form (link below)
You will need to notify all of your medical providers of your new name and/or address change including your Physician, Medical plan, Dental plan, and Disability plan. The enclosed Notice of Name Change Form contains the information medical organizations require. There are thousands of medical providers around the country. They have many different requirements to change your record with them. If they have an additional form that requires submission, sending them the enclosed form will put them on notice to send you any additional requirements they many have. Make as many copies of the Notice of Name Change Form as you require.
Click here for the Notice of Name Change Form
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NAME CHANGE TOOL KIT