Get the free Oregon Physical Therapist Name Change Form - oregon

This document is used by physical therapists in Oregon to report a change of name or address to the licensing board, as required by law. It includes instructions for submission and requirements for

How to fill out oregon physical therapist name

How to fill out Oregon Physical Therapist Name Change Form

1. Obtain the Oregon Physical Therapist Name Change Form from the Oregon Physical Therapy Licensing Board website.
2. Fill out the required personal information including your current name, new name, license number, and contact information.
3. Attach any required documentation that supports your name change, such as a marriage certificate or court order.
4. Sign and date the form to certify that the information provided is accurate.
5. Submit the completed form along with any required fees to the Oregon Physical Therapy Licensing Board via mail or online, if applicable.

Who needs Oregon Physical Therapist Name Change Form?

1. Licensed physical therapists in Oregon who have legally changed their name and want their licensing records updated.

People Also Ask about

How do I change my name on my Oregon Health Plan?

If you'd like to change your name or address with the Oregon Health Authority, contact their customer service at 800-699-9075 (TTY 711).

How do I change my name on my vital records in Oregon?

Go to the Oregon Vital Records office or send your application there. You will need: – A photocopy of your ID – Your notarized application – A form called a Birth Record Order Form – Money to pay the fees for your name change.

How to change name with OHP?

You can call ONE Customer Service at 800-699-9075 to report changes to OHP. You can call Monday-Friday, 7 a.m. to 6 p.m. Pacific Time. Currently hold times are lowest in the morning from 7 until 8 a.m.

How do I change my last name on my health insurance card?

Name changes Most insurances won't allow a verbal name change over the phone; they will likely require some form of proof. What constitutes as proof will vary by insurer but typical items will include a certified copy of your marriage license, divorce decree, birth certificate, or other legal document.

How do I change my name on my vital records in Oregon?

Go to the Oregon Vital Records office or send your application there. You will need: – A photocopy of your ID – Your notarized application – A form called a Birth Record Order Form – Money to pay the fees for your name change.

For pdfFiller’s FAQs

What is Oregon Physical Therapist Name Change Form?

The Oregon Physical Therapist Name Change Form is a legal document that allows licensed physical therapists in Oregon to officially change their name in the state registry.

Who is required to file Oregon Physical Therapist Name Change Form?

Licensed physical therapists who have legally changed their name and wish to update their name in the state records are required to file this form.

How to fill out Oregon Physical Therapist Name Change Form?

To fill out the Oregon Physical Therapist Name Change Form, you must provide your current name, the new name you wish to adopt, your license number, and other personal identification information as specified on the form.

What is the purpose of Oregon Physical Therapist Name Change Form?

The purpose of the Oregon Physical Therapist Name Change Form is to ensure that the state has accurate records of licensed practitioners, thereby facilitating proper identification and legality of practice under the new name.

What information must be reported on Oregon Physical Therapist Name Change Form?

The information that must be reported includes your current name, the new name, license number, date of name change, signature, and any supporting documentation that may be required, such as a marriage certificate or court order.