OFFICIAL FORM(S) REQUIRED:
• Notice of Name Change Form
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 Name Change Form
