Report Problem Changing a State or Federal Document

Please fill out this form as completely as possible. Contact information given here is strictly confidential, and will be used to inform you of MTPC’s future advocacy efforts. * = required

Documentation Type

MA Document Type *

About You

First Name *
Last Name *
Address 1
Address 2
City/Town *
State *
Zip
Email *
Phone
Weekdays, do NOT call before: HHMMAM/PM
Weekdays, do NOT call after: HHMMAM/PM

Basic Information

Location: *
Date it happened (approximate OK) *
What you attempted to change: *
NameGender
Obtained Result:
Gender ChangedName ChangedBoth ChangedNeither Changed
What documentation did you show?
Did you submit a letter from your doctor? *
YesNo
If yes, what type of doctor (surgeon, internist, etc.)
What other documentation did you show?
How easy was changing your document? *
VerySomewhatNot at all
Was the staff Respectful? *
VerySomewhatNot at all
Was the staff Knowledgeable? *
VerySomewhatNot at all
Was the staff Helpful? *
VerySomewhatNot at all
Narrative
What happened & how you felt about it:

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Documentation Type

About You

Basic Information

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