Exceptional Care, Affordable Pricing
 
Schedule An Appointment Today!

Tell us about yourself so we can provide you with the correct amount of time for an appointment.

Please fill out the form below to schedule an appointment. If you would rather discuss your personal medical and eye care history and set up and appointment at Eye 35 via phone, you can call our office at 952-435-3505.

First Name:
Middle Initial:
Last Name:
Street Address:
Street Address Line 2:
City:
State:
Zip Code :
Email Address:
Primary Phone #: Format: xxx-xxx-xxxx
Secondary Phone #: Format: xxx-xxx-xxxx
Monday 9:00 am - 6:00 pm
Tuesday 9:00 am - 5:00 pm
Wednesday 9:00 am - 7:00 pm
Thursday 9:00 am - 5:00 pm
Friday Closed
Saturday 9:00 am - 12:30 pm
Sunday Closed
Closed 1:00 – 2:00 daily

Patient Status :

When was your last eye exam?

Which of the following do you wear?

What are your primary eyecare interests?
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Date of Birth :

Reason for scheduling appointment :

What day/s of the week work best for a consultation?
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What time of day is best for an appointment?
Afternoon Appointment

Is the time day of the day or the day of the week most important for your appointment?
Day of the week

Will we try and schedule your appointment with your chosen preference. Tammy will contact you to confirm the date and time. How would you like to be contacted?
Email

Eye 35 Eye Care accepts most insurance plans including but not limited to: Blue Cross - Blue Shield, Medica, Health Partners, Preferred One, Patient Choice, and Eye-Med. Please fill in your information below and we will let you know what your insurance provider offers.
Insurance Company Name
Group ID
Insured ID