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TX DSHS Name Change and/or Duplicate License Form 2020-2025 free printable template

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Name Change and/or Duplicate License CST PLU HHSC Mail Code 1470 PO Box 149055 Austin, Texas 787149055 Phone: (512) 8344530 Fax: (512) 8346677 Email: cost DSS. Texas.budget: ZZ118 FUND: 087 Submit
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TX DSHS Name Change and/or Duplicate License Form Form Versions

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TX DSHS Name Change and/or Duplicate License Form 2020
4.8 Satisfied (65 Votes)
TX DSHS Name Change and/or Duplicate License Form 2018
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How to fill out TX DSHS Name Change andor Duplicate

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How to fill out TX DSHS Name Change and/or Duplicate License

01
Obtain the TX DSHS Name Change and/or Duplicate License form from the Texas Department of State Health Services website.
02
Fill in your current license information, including your name, license number, and date of birth.
03
Provide your new name if you are applying for a name change.
04
Attach any required documentation, such as a marriage certificate, divorce decree, or court order that verifies the name change.
05
Include a check or money order for the applicable fee, if required.
06
Sign and date the form.
07
Submit the completed form and documents to the address specified on the form.

Who needs TX DSHS Name Change and/or Duplicate License?

01
Individuals who have legally changed their name and need to update their health license.
02
Persons who have lost their health license and require a duplicate copy.
03
Those whose personal information on the license has changed due to marriage, divorce, or court order.
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TX DSHS Name Change and/or Duplicate License is a process that allows individuals to update their name on their Department of State Health Services (DSHS) issued licenses or to obtain a duplicate license if the original has been lost or damaged.
Individuals who have legally changed their name or those who have lost or damaged their DSHS issued license are required to file for a Name Change and/or Duplicate License.
To fill out the TX DSHS Name Change and/or Duplicate License form, individuals must complete the designated application form, provide proof of the name change (if applicable) such as a marriage certificate or court order, and submit the required fee.
The purpose of TX DSHS Name Change and/or Duplicate License is to ensure that the official records reflect the individual's current legal name and to provide a replacement for licenses that are lost or damaged.
The information that must be reported includes the individual's current and previous names, license number, date of birth, contact information, and any relevant documentation supporting the name change or proof of loss/damage of the license.
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