Get Tx Dshs Name Change And/or Duplicate License Form 2020-2026

Filling out the Texas Department of State Health Services (TX DSHS) Name Change And/or Duplicate License Form online is a straightforward process. This guide will walk you through each component of the form, ensuring you can complete it accurately and confidently.

Follow the steps to successfully complete the form online.

1. Click the 'Get Form' button to access the form and open it in your preferred editor.
2. Provide your licensee profile data: Input your ASOTP or LSOTP number, the date issued, and the expiration date in the respective fields.
3. Enter your current name: Fill in your last name, first name, and middle name as they appear on your current license.
4. If you are requesting a name change, enter your new name: Fill in the last name, first name, and middle name that you wish to be recognized by.
5. Complete your address details: Provide your street address, city, state, and ZIP code.
6. Add your email address: Ensure it is accurate so that you can receive confirmation or any further communication.
7. Attach the required verifying documents: If you are requesting a name change, include supporting documents such as a photocopy of your new social security card, driver's license, or marriage certificate.
8. Include the payment: A $10 fee must accompany your application for a duplicate license or name change. Ensure this is submitted with your form.
9. Review your entire form: Check all the information for accuracy to prevent any delays in processing.
10. After reviewing, save your changes, and download the completed form. You may also print or share it as necessary.

Complete your TX DSHS Name Change And/or Duplicate License Form online today.