INSTRUCTIONS: APPLICATION FOR NAME CHANGE ALABAMA MEDICAL LICENSE

To apply for a name change on an Alabama medical license, file the form discussed in this article. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners & Medical Licensure Commission of Alabama. Note that this is not the same form that is filed in the event that you need to have your wall certificate replaced due to a name change. That document can also be obtained from the website maintained by the Alabama Board of Medical Examiners & Medical Licensure Commission of Alabama. Similarly, documentation of a change of either your professional or medical address is accomplished using a separate change of address form.

Application For Name Change Alabama Medical License Step 1: On the first blank line, enter your license number.

Application For Name Change Alabama Medical License Step 2: On the second blank line, enter your previous name.

Application For Name Change Alabama Medical License Step 3: On the third blank line, enter your new name.

Application For Name Change Alabama Medical License Step 4: On the fourth blank line, enter your mailing street address or P.O. box number.

Application For Name Change Alabama Medical License Step 5: On the fifth blank line, enter your city.

Application For Name Change Alabama Medical License Step 6: On the sixth blank line, enter your zip code.

Application for Name Change Alabama Medical License Step 7: The line for the state has already been filled in with "Alabama."

Application For Name Change Alabama Medical License Step 8: On the seventh blank line, write the legal reason for your name change.

Application For Name Change Alabama Medical License Step 9: On the eighth blank line, enter your signature.

Application For Name Change Alabama Medical License Step 10: On the ninth blank line, enter the date.

Application For Name Change Alabama Medical License Step 11: Before submitting the form, you must obtain the legal document verifying a name change due to marriage, divorce, a court order or the other cause of your name change. This document must be submitted along with your application.

Application For Name Change Alabama Medical License Step 11: Submit the application and supporting documentation to the address given at the bottom of the page.