Forms & Services  »   Chiropractic Assistants (CA): General  »

Notification of Name Change (CA)

 Description

This form is used to officially notify the Board of a legal name change. All Chiropractic Assistants must report any name changes within 60 days of the effective date.

Applicants must submit proof of the name change and return their current license or registration. If the name change is reported late, a penalty may apply and must be paid before processing can occur.

Estimated Time to Complete: 5–10 minutes, assuming all required documentation is complete and ready to submit.
 Required Documentation*

IMPORTANT: Please have all required documentation ready before purchasing. You will be asked to send these documents as part of the online process.

Documentation to be sent by the applicant or license/registration holder:
  • Completed .pdf Application (including additional required documents mentioned in .pdf)

*The documents listed are the materials generally required to meet the Board’s requirements. Additional documentation may be requested if needed to complete the review.

 Instructions
Upload Your Form & Documentation

After payment, you’ll be able to upload your files.