SDSC CIV-393 (New 2/18) DECLARATION OF PHYSICIAN RE CHANGE OF GENDER Health & Saf. Code §§ 103425, 103430,

Cal. Form CIV-393

California Superior Local Rules

SDSC CIV-393 (New 2/18) DECLARATION OF PHYSICIAN RE CHANGE OF GENDER Health & Saf. Code §§ 103425, 103430, Optional Form 103435, 103440 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: FAX NO.(Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA CENTRAL DIVISION, CIVIL, 330 W. BROADWAY, SAN DIEGO, CA NORTH COUNTY DIVISION, 325 S.

MELROSE DR., VISTA, CA PETITION OF: DECLARATION OF PHYSICIAN RE CHANGE OF GENDER CASE NUMBER I, , am a licensed physician in the state of . I attest that petitioner , whose medical record indicates a date of birth of , is a patient of mine for the purpose of gender transition. I attest the petitioner has undergone the clinically appropriate treatment for the purpose of gender transition to male female. Physician’s Medical License or Certificate Number: Physician’s Address: Physician’s Tel. No.: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: Signature

Document details

Collection	California Superior Local Rules
Citation	Cal. Form CIV-393
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	35ea68e26d435c5a486d29437cd82415d9439933

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