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Get Aetna Order Form 2007-2024

Ayment on this order. ■ If you have an unpaid balance with our pharmacy this order may not be processed until payment is received. ■ If you have a Flexible Spending Account (FSA) auto-debit feature, or are enrolled in an Aetna HealthFund® or Vital Savings on Health plan, please provide a personal credit or debit card to cover any expenses that may exceed your account balance. ■ If you are enrolled in an FSA, Health Savings Account (HSA) or Vital Savings on Health program and have a FSA/HS.

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