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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Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

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Health Care Professionals, Request to Use Aetna Logo

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