Physician Assitant Committee - Name Change Form - pac ca 2025

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Name Change Due to Marriage Pennsylvania does not require a name change for marriage. If the applicant wishes to change his/her name after marriage, certified copies of the marriage record will be required in order to change your drivers license and social security card.
If you change your name after you have submitted an application or are licensed, you must submit a signed Notification of Name Change form , along with photocopy or electronic copy of a current government-issued photographic identification (e.g., drivers license, alien registration, passport, etc.)
To change a name on your drivers license or ID, visit a Driver License Center(opens in a new tab) and bring the completed form. For a birth name, bring your state-issued birth certificate with a raised seal. If your name changed by permission of the court, you must present a Certified Copy of the Court Order.
NAME CHANGE: To notify PTBC of a name change, submit a Request for Name Change online prior to submitting your renewal. Once submitted, the Board will process your request within 14 days. Please allow PTBC six (6) weeks to process your renewal application and payment.
Name Change Filing Fees StateFiling Fee PA $300 - $350 RI $89 SC $150 SD $7047 more rows
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Pennsylvania does not have official statewide name change forms. Some county court systems offer a name change form for use in that county, which may be obtained from the court systems website, or in some cases exclusively from the courthouse.
You will need to update your name on your medical records. You can send a form like this to each of your medical providers, along with a copy of your marriage certificate so they are aware of the change. Get in touch with your medical insurance provider and find out what they require for an official name change.

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