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 (redirected to website)

Swoop Intake Form


DOWNLOAD (English)

Swoop Intake Form Download


Descargar el formulario (Español)

Swoop El Formulario (Español)

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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Privacy Forms

  • Acknowledgement of Receipt of Notice of Privacy Practice

  • DOWNLOAD

  • Notice of Privacy Practices

  • DOWNLOAD


​​​​​​​Pre-Authorization Insurance Forms

  • Auto-Insurance Patient Agreement

  • DOWNLOAD

  • Worker’s Compensation Patient Agreement

  • DOWNLOAD


​​​​​​​Medically Necessary Glasses Forms

  • Advanced Beneficiary Notice (ABN) – Medicare

  • DOWNLOAD

  • Credit Card Authorization for Non-Covered Medically Necessary Eye Wear

  • DOWNLOAD


​​​​​​​Medical Records

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