Medical Application Request Form

Medical

Interested in joining the Aetna network? Learn more about our application and credentialing process here. The site also has information on the Council for Affordable Quality Healthcare's (CAQH's) Universal Provider Datasource® and ProviderSource™ (for Washington State licensed practitioners). 

Or to get an application, please complete the form below: 

As a practitioner, you have the right to correct discrepant or erroneous information obtained during the credentialing process by working directly with any reporting entities.

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