Request a printed directory

1. Section
2. *MEMBER ID
3. *FIRST NAME
4. MIDDLE INITIAL
5. *Last Name
6. Phone number
7. Email Address
9. I would like to opt-in to receive an English/Spanish Medicare printed directory annually.
12. EMPLOYEE ID*
13. Mail me a printed directory

• Section

Get the directory for your plan

Complete the form below. Make sure you have your member ID card because you'll need it to make your request. All fields marked with an asterisk (*) are required.

Enter the Aetna Member ID that is on your card. Your member ID will contain 12 numeric characters.

*MEMBER ID

123456789012

*FIRST NAME

MIDDLE INITIAL

*Last Name

Phone number

123-456-7890

Email Address

example@gmail.com

I would like to opt-in to receive an English/Spanish Medicare printed directory annually.

Yes

No

For certain counties in California and New York, English/Chinese directory PDFs are available online. You can view them by going to
AetnaMedicare.com/findprovider.

Need a printed copy in another language or alternate format? Please call Member Services. The phone number is on your member ID card.

The field below is for internal customer service use only.

EMPLOYEE ID*

*Required if completing form for a member.

Mail me a printed directory