Health Care Professionals, Request to Use Aetna Logo

For contracted Aetna health care providers: Use this form to request permission to display the Aetna logo on your website. This display is to indicate that you currently accept Aetna coverage.

Other logo permissions – online form

Please enter your contact information

All fields marked with a RED asterisk(*) are required in order to proceed.

*I am a current Aetna Participating Doctor or other Health Care Provider or Facility

Yes

* Doctor or Hospital Name

Practice Name

Job Title

* Address

* City

*State

*5 digit ZIP code

Country

International postal code

* Contact last name

* Contact first name

Phone number (10 digits)

International phone number

Fax number (10 digits)

* Email address (formatted as example@sample.com)

* Provide website address (formatted as www.website.com)

*Will the Aetna logo be associated with any Medicare offerings?

Yes

Click on the Submit button below to be taken to the Terms of Use of the Aetna logo:

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Do you have Aetna insurance through an employer or are you a Medicare member? Yes No

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Do you have Aetna insurance through an employer or are you a Medicare member? Yes No

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Health Care Professionals, Request to Use Aetna Logo

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