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If Banner|Aetna’s connected care has helped you, we’d like to hear from you. You can tell us about your experience by filling out the form below.

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Disclaimer: Please only use this form to tell us about your experience.

Please read the Authorization for release form and check the box below.

Authorization for Release Form

*Authorization

I hereby grant to Banner|Aetna and its affiliates (Aetna and Banner Health Network), and their respective licensees, agents, successors and assigns (collectively “Banner|Aetna”) the unconditional right to use my name, likeness, voice, biographical information and/or statements made by me, in whole or in part, in any print or electronic media now or hereafter known, including without limitation, still photographs, motion picture films, video and/or sound recordings (“the Materials”) in the JV Value Story Video, in advertising, in marketing materials, or for any legal purpose. Such materials shall be used for the sole purpose of describing my opinion as a member of Banner|Aetna.

Banner I Aetna will own all rights to the Materials, including copyrights.

Any statements made by me are true and accurate to the best of my knowledge. I hereby release Banner|Aetna from any and all claims or liabilities relating in any way to the use of the Materials as described herein, including without limitation, all claims relating to rights of publicity, rights of privacy, moral rights or similar rights. Banner|Aetna shall not be liable to the undersigned for any distortion or illusionary effect resulting from the use of the undersigned’s name, likeness, voice, biographical information or statements.

Transforming health care, together

Together, Banner Health and Aetna aim to offer more efficient and effective patient care at a more affordable cost. We join the right medical professionals with the right technology, so patients benefit from quality, personalized health care designed to help them reach their health ambitions.

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Health benefits and health insurance plans are offered and/or underwritten by Banner Health and Aetna Health Plan Inc. and Banner Health and Aetna Health Insurance Company (Banner l Aetna). Banner l Aetna are affiliates of Banner Health and Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Banner l Aetna. Banner l Aetna is the brand name used for products and services provided by Banner Health and Aetna Health Plan Inc. and Banner Health and Aetna Health Insurance Company.

This material is for information only and is not an offer or invitation to contract. Providers are independent contractors and are not agents of Banner l Aetna. Provider participation may change without notice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.

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Banner|Aetna is the brand name used for products and services provided by Banner Health and Aetna Health Insurance Company and Banner Health and Aetna Health Plan Inc. Health benefits and health insurance plans are offered and/or underwritten by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. (Banner|Aetna). Each insurer has sole financial responsibility for its own products.  Banner Health and Aetna Health Insurance Company and Banner Health and Aetna Health Plan Inc. are affiliates of Banner Health and, of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Banner|Aetna.

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Links to outside sites are provided for your convenience only. Banner and Aetna and its affiliates are not responsible for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

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Banner|Aetna is the brand name used for products and services provided by Banner Health and Aetna Health Insurance Company and Banner Health and Aetna Health Plan Inc. Health benefits and health insurance plans are offered and/or underwritten by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. (Banner|Aetna). Each insurer has sole financial responsibility for its own products.  Banner Health and Aetna Health Insurance Company and Banner Health and Aetna Health Plan Inc. are affiliates of Banner Health and, of Aetna Life Insurance Company and its affiliates (Aetna). Banner Health provides certain management services to Banner|Aetna.

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