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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:

Contact Lens Fees - Download & Print

Privacy Practices - Download & Print

Optomap and M-Pod Consent Form - Download & Print

Patient General Information - Download & Print

Patient Medical History Form - Download & Print

Patient Consent to Release Information - 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.

  • Aetna
  • Allina
  • Advantage Plan
  • Selectcare PPO
  • Blue Cross Blue Shield
  • Medica Medicare
  • Cigna
  • Comprehensive Care Services
  • LaborCare
  • Coventry Health Plan
  • Definity Health Plan
  • Great West Health Plan
  • United Healthcare Options PPO
  • Health Partners
  • Humana
  • Medicare

  • Medicare BCBS PPO
  • Medica
  • Patient Choice
  • Medica Choice/Medica Self-Insured
  • Preferred One
  • Medica MIC Choice
  • Select Care
  • TriCare
  • 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

To Our Valued Patients:

As an essential business, Kennedy Vision Health Center remains committed to patient and employee safety as we navigate through the current healthcare crisis. We are going to see patients again beginning May 4th.  We care deeply about patient health and have implemented several infection prevention measures to ensure the highest level of safety when you visit our clinic.  Following guidance from  the MN Dept. of Labor, MN Dept. of Health, CDC, and the American Optometric Association we are keeping a very controlled and safe environment for our patients and employees.

For patients being seen in our clinic, the CDC is now recommending that all staff, patients and visitors cover their faces in health care facilities. To help reduce the spread of COVID-19, we are requiring patients to bring and wear a face covering (such as protective mask or cloth covering) to any upcoming appointments.

Masks or cloth coverings must be worn over your mouth and nose for the duration of your appointment. Members of your care team will also wear masks to help reduce the spread of COVID-19. If you do not have access to a face covering, the CDC website has guidelines for making no-sew, cloth face coverings. You can also use a scarf or bandana. Additionally, masks can be purchased from many local and online retailers.

We are requiring an appointment to enter the office.  Appointments will be made for eye exams, glasses, and contact lens pickups.  If you do not have an appointment please call before entering so we can make sure we do not have too many people in the office.  Once entering please use the hand sanitizer that is provided in the foyer and wait to approach the front desk until the receptionist is ready.  All people entering the building must have their temperature checked.  If your temperature is above 100.4, it will be rechecked by a different device, and if still high you will need to reschedule.

We continue to ask that you do not bring any unnecessary people with you to your appointment, with the exception of a guardian with a child or assistance with mobility.  Also, please follow the 6 feet social distancing guidelines as much as possible throughout the office.

Rest assured that every surface you come into contact with has been sanitized prior to the arrival of each and every patient entering our practice, and it will be cleaned again as you exit each area. The team will be frequently washing their hands between interactions as per our usual protocol, and you’ll also see hand sanitizer throughout the practice for your use, as well.

If you’re  wanting to purchase glasses, there is a similar protocol in place to ensure a safe interaction with cleaning of frames and minimal contact with our optical team. Please follow their direction if eyewear is needed.

Kennedy Vision Health Center is also offering telemedicine visits which can be completed from the comfort of your home. To schedule a telemedicine visit please contact our office at 763-545-8850 and one of our team members will be happy to schedule your visit.

If you have any questions or concerns, please don’t hesitate to call us. On Monday May 4th we will begin regular office hours at both locations.

We appreciate your efforts to help protect yourself, our care teams and our entire community.