Patient Center

Online Forms

Please use the links below to download printable PDF versions of our patient forms, and bring them with you on your visit to our offices:

Patient General Information - Submit Online | Download & Print

Kennedy Vision Health Center HIPPA Policy - Download & Print

Optomap-Consent-Form - Submit Online | Download & Print

Patient History Form - Submit Online | Download & Print

Patient Medical History Form - Submit Online | Download & Print


As a service to our patients, Kennedy Vision Health Center is pleased to offer the CareCredit card, North America’s leading patient payment program. CareCredit has a full range of payment plans to meet every financing need, including no interest and low interest options.

No Interest Payment Plans

Extended Payment Plans


Payment Options

At Kennedy Vision Health Center, our mission is to provide quality service and products at reasonable pricing. We accept the following payment methods:

  • Cash
  • Check
  • Visa, MasterCard, American Express and Discover
  • Flexible Spending Plans
  • Health Savings Accounts (HSA)
Participating Insurances
Kennedy Vision Health Center submits to the insurance carriers listed below. If you don't see your insurance carrier listed, contact us at (763) 545-8850 to see if the carrier has recently been added. We also accept patients who want to self-pay for their exam. If we do not carry your insurance or vision plan we will give a discount on services and/or products.

Allina Advantage Plan
Selectcare PPO
Blue Cross Blue Shield
Medica Medicare
Comprehensive Care Services
Coventry Health Plan
Definity Health Plan
Great West Health Plan
United Healthcare Options PPO
Health Partners
Medicare BCBS PPO
Patient Choice
Medica Choice/Medica Self-Insured
Preferred One
Medica MIC Choice
Select Care
Medica Elect
U Care
Medica Premier
United Health Care
Medica Choice Care & Medica Minnesota Care
(VSP) Vision Service Plan

Carriers listed are organizations that Kennedy Vision Health Center submits claims too. Submitting a claim does not guarantee coverage. Be sure to check with your insurance carrier for specific coverage levels.

  • Discounts are only given if the payment is made on the day of service
  • A 20% discount is given for patients with EyeMed, Spectara, or Davis Vision Plans

Corporate Accounts:
Kennedy Vision Health Center has corporate account relationships with the following organizations. If your organization is interested in opening a corporate account with us, call (763) 545-8850.

  • Honeywell
  • Progress Casting
  • Sifco Custom Machining