American Health Source

Your Current Member Name
If you recently had a name change, please give us your new last name:
New Last Name
Name Change Requirement: Please submit a proof of the name change to the AHS Office. Please attach a copy of the legal court record such as a marriage license, divorce decree or a court-approved name change document, supporting the name change. If you wish to have a new certificate, please follow the directions of the Replacement of Certificates along with the proof of the name change.
Your AHS Member Number
Email Address
Confirm Email Address
Home Phone with Area Code
*YOUR OLD ADDRESS*
Street Address
City and State
Zip Code
*YOUR NEW ADDRESS*
Street Address
City and State
Zip Code
Questions / Comments