Get aetna short term disability form

Aetna Life Insurance Company PO Box 14560 Lexington, KY 40512-4560 ACS Fax#: 866-667-1987 Attending Physician Statement 1. Patient Information Patient Name Year of Birth Claim Number Employer Name Job Title Please complete all of the fields below and fax this form back to 866-667-1987 within 2 business days from receipt of this request. If you have any questions or would like to provide this information over the...
Fill & Sign Online, Print, Email, Fax, or Download
Fill Online
  • Fill Online
  • eSign
  • eFax
  • Email
  • Add Annotation
  • Share
aetna short term disability form
Rate This Form