If you change your name after you have submitted an application for a Physician's and Surgeon's (P&S) or Postgraduate Training License (PTL), you must submit a signed Notification of Name Change form , along with a photocopy or electronic copy of a current government-issued photographic identification, such as a driver's license, alien registration or passport and one of the following legal documents as proof of the name change:
- Marriage Certificate
- Dissolution of marriage (divorce)
- Certified Court Order
If you hold a P&S or PTL, you must complete a Notification of Name Change Transaction using the BreEZe Online Services. Be sure to upload all required legal documentation (e.g., marriage certificate, court order) to support your request to the Board.
Effective August 1, 2026, Name Change Requests for P&S and PTLs will no longer be accepted via mail.
Name and Gender Change Notification and Request for Confidentiality (SB 372, 2023)
Effective January 1, 2024, under Business and Professions Code section 27.5, licensees may notify the licensing board or bureau within the Department of Consumer Affairs of a name and/or gender change and request confidentiality of the previous name or gender information, when meeting certain specified requirements. For more information and to make a request, click here.
