Address:
817 East 66th St.
Richfield, MN 55423
Online Forms
Patient Forms
Thank you for choosing Swoop Eye Care for your eye & vision care needs!
Please arrive 10 minutes prior to your appointment time. If you have provided your medical insurance information and completed the online paperwork, you are all set! If you have not, please complete steps 1-3.
Step 1: PATIENT INTAKE FORM
Electronic Patient Intake Form
- Swoop Intake Form
Swoop Intake Form Download (English)
- Download
Descargar el formulario (Español)
- Descargar
Step 2: PROVIDE INSURANCE INFORMATION
Medical Insurance: If you are using your medical insurance, text, or call (612) 488-1566 or email (info@swoopeye.com) a copy of your medical insurance card.
Auto Insurance: If you were involved in a motor vehicle accident, you must complete the Auto Claim Form prior to your visit. You will also be asked to provide your medical insurance information.
Worker’s Compensation: If you were injured at work, you must complete a WORKER’S COMP form prior to being seen by your neuro-optometrist. You will also be asked to present your medical insurance information.
No-Insurance or Self Pay: Depending on the services provided will dictate the pricing of your exam. Please inquire with our business office.
DISCLAIMER: Please provide the most updated information. Inaccurate or incomplete information will result in delayed service and treatment for you. These forms do not guarantee payment for services rendered. Our office uses the information to bill your insurance. Insurance determines coverage and eligibility.
Step 3: NEW PATIENT/OUTSIDE REFERRAL
If you have a complicated medical eye history or a patient referral from an outside provider, we recommend that you request patient records to be sent to our clinic fax
Fax: (612) 488-1564
We look forward to being part of your healing journey to wellness!
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