Patient Center

Patient Center

At Belle Plaine Eyecare Center we believe in continual improvement of our services. Please take a few moments and share your experience with our office. We appreciate your feedback!

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Online Forms

Speed up your visit by completing the necessary form(s) below. For your convenience, you can either fill the form(s) out online or download and print the form(s) and bring it with you to your appointment.

Adult Patient Forms

Patient Demographic Form - Download & Print

Adult History Form - Download & Print

Privacy Form - Download & Print

Child Patient Forms

Patient Demographic Form - Download & Print

Child History Form - Download & Print

Privacy Form - Download & Print


Payment Options

At Belle Plaine Eyecare Center, our mission is to provide quality service and products at reasonable pricing. We accept the following payment methods:

Our Office Accepts

• Cash
• Check
• Visa, MasterCard, American Express and Discover
Care Credit
• Flexible Spending Plans
• Health Savings Accounts (HSA)

Participating Insurances

Our practice accepts most insurance plans. Coverage may vary from one plan to the next. Please call our office to verify your benefits before your visit.