Delaware Healthcare Provider's Affidavit for Sex Change on Birth Certificate
Official state formSex designation changeFree downloadLast verified November 10, 2026
Notarized affidavit signed by the patient's U.S.-licensed health care provider in support of a sex change on a Delaware birth certificate. The requester submits it with the Requester's Affidavit.
Who can use this form
- Signed by the patient's U.S.-licensed health care provider in good standing
- Provider types listed: physician, doctoral-level psychologist, nurse practitioner, social worker, physician assistant, mental health counselor, midwife
- The provider must have treated the patient in a doctor/patient relationship
What to send with it
- Affidavit signed by the provider and notarized
- Provider's letterhead, or the provider's address, telephone and email on the form
- Provider's license number, state issued, license type and NPI number
- Submitted with the Requester's Affidavit, court order if there is a name change, photo ID and original birth certificate
- $25 by check or money order only if the registrant has no existing birth certificate
Where to send it
- Mail to
- Office of Vital Statistics Jesse Cooper Building 417 Federal Street Dover, DE 19901
- State fee
- $25 only if the registrant has no existing birth certificate (per the office's Gender Reassignment checklist)
- Typical processing
- Within two weeks (stated on the office's Gender Reassignment checklist)
- Form revision
- Effective 2/11/2017
- Source
- Official government page