Change location form 2026

See details

4.8 out of 5

166 votes

The document is an application form from the California Department of Public Health for health facilities or agencies seeking to change their location. It outlines the required information about the current facility, licensee details, new location information, property ownership, and compliance with local ordinances and health codes. The form emphasizes the need for documentation regarding construction compliance and fire safety inspections.

Here's how it works

01. Edit your provider website online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send facility change form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out change location form with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the change location form in our editor.
Begin by filling out Section A, CURRENT FACILITY INFORMATION. Enter the facility name, type, current street address, and days and hours of operation.
Proceed to Section B, LICENSEE INFORMATION. Input the licensee's full legal name, license number, Federal Employer’s Tax ID Number, and contact details including address, telephone number, fax number, and email address.
In Section C, FACILITY, AGENCY OR CLINIC NEW LOCATION INFORMATION, provide the new street address and contact information for the facility. If construction is required, indicate 'Yes' or 'No' and include relevant dates.
Complete Section D by entering property information for the owner of record, lessee, and sub-lessee as applicable. Ensure all necessary documentation is attached before submission.

Start using our platform today to streamline your document editing and form completion process for free!

See more change location form versions

We've got more versions of the change location form form. Select the right change location form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (166 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

facility change

Change location form usps Change location form pdf Change location form online USCIS change of address USPS change of address USCIS change of address online USCIS change of address Form pdf Immigration Change of address Form