Submit Your Story

Disclaimer: Please only use this form to tell us about your health care success stories. For any other communications, please call the number on the back of your member ID card to speak to a customer service representative.

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

Authorization for Release Form

I hereby grant to Innovation Health and its affiliates (Aetna and Inova), and their respective licensees, agents, successors and assigns (collectively “Innovation Health”) 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 Innovation Health.

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 Innovation Health 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. Innovation Health 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.