Health Care Professionals, Request to Use Aetna Logo

(Includes an Option to Use the Aetna Logo as a Link to the Aetna.com Home Page)

For Current Aetna Participating Doctors and Hospitals

Please use this form to request permission to display the Aetna Logo on your Internet site for the purpose of indicating you are a current Aetna participating doctor or hospital (with or without a link)

For all other needs, please click here.

Thank you for your interest in using the Aetna Logo. We would like to gather some basic information from you for our records. Upon submission of this form, and your agreement to be bound by the Terms of Use of the Aetna Logo, you will automatically be provided with instructions on how to download the Aetna Logo and link to the Aetna.com home page.

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

Title

*Address

Country

International postal code

*Contact Last Name

*Contact First Name

Phone Number

International phone number

Fax Number

*Your Email Address

*Your Website URL

To proceed you must read and agree to abide by the Terms of Use of the Aetna Logo by clicking on the Submit button below:

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Health Care Professionals, Request to Use Aetna Logo

Please enter your contact information

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