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Click ‘Get Form’ to open the California Petition for Change of Primary Treating Physician in our editor.
Begin by filling in the employee's name and address at the top of the form. Ensure accuracy as this information is crucial for processing.
Next, provide details about the employer and claims administrator, including their addresses. This establishes the context of your petition.
List the names, addresses, and medical specialties of five physicians in the designated panel section. Remember to include a chiropractor if applicable.
In Part A, articulate your reasons for requesting a change of physician. Attach any supporting documents that substantiate your claims.
Complete the verification section by signing and dating it. This confirms that all provided information is accurate.
Finally, ensure you attach a proof of service declaration indicating that all parties have been notified about this petition.

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How do you petition someone to change your name in California?

In California, you can ask for a court order to change your legal name. To do this, you file a petition with the court and publish a notice in a newspaper. Then, youll either have a court date (a hearing) where a judge will make a decision, or the judge may make a decision without a hearing.

How much does it cost to petition for a name change?

The cost to legally change your name can vary greatly by jurisdiction. Typically, youll need to file a petition for a name change with your local court, which involves a filing fee. These fees can range anywhere from $50 to several hundred dollars.

How do I report a change petition?

How to report a petition Scroll to the bottom of the petition description and click on Report a policy violation button located below the comments section. This button opens a menu where you will select a category for your report. Before you can make a submission, you must include a reason for your report.

Can you still change gender in California?

In California, you can ask the court for an order recognizing your gender change and changing your legal name. To do this, you file a petition with the court and get a decree. The process generally takes up to 2 months.

California petition change 2025

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How to use or fill out California Petition Change with DocHub

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Got questions?

How do you petition someone to change your name in California?

How much does it cost to petition for a name change?

How do I report a change petition?

Can you still change gender in California?

Try more PDF tools

California petition change 2025

Here's how it works

How to use or fill out California Petition Change with DocHub

Complete this form in 5 minutes or less

Got questions?

How do you petition someone to change your name in California?

How much does it cost to petition for a name change?

How do I report a change petition?

Can you still change gender in California?

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