If you are an existing patient needing help, we have a few options for you.
1. Use our patient portal.
2. OR – Call us at 630-371-9980
3. OR – If you are having any difficulty with the phone system, please email at PatientHelp@painchicago.com
4. OR – fill out the following form:
Please complete pain diagram and bring to your appointment. If there are any Demographic/Insurance changes or HIPAA updates, please complete and bring to your appointment. Thank you.
- Patient Demographics
- Signature Sheet
- Pain Diagram
- HIPAA Form
- ARI Form
- Insurance Communications Consent (ICC)
- COVID 19 Consent Form
- Requisition for Forms – FMLA and Other
- Authorization for Release of Medical Records
(Please complete a request for form and fax it to our office at 630-371-1555. There is a 10 business day turnaround time)
- Self Pay Policy Form
- New Patient Packet
- MR Release Form
- Curbside Office Visit Instructions
- Request Medical Records
- Benefits Assignment Policy
- ICC (Portal)
- Interventional Procedure Instructions
- Notice of Privacy Practices
- Opioid Policy
- Controlled Substance Agreement
- Opioid Consent for Treatment
- Controlled Substance Policy
I had the best experience with Tia one of the NPT. Injection in my left knee, within hours I had total relief. Thank you Tia
I wanted to take a moment to praise Dr. Glaser, Maria (nurse practitioner) and the entire staff. When I was first referred to Dr. Glaser, I was experiencing severe pain from Fibromyalgia and he found that I had bursas in both shoulders. I could not lift my arms above my waist and was in chronic pain all the time. After treatment and pain medication, I am now able to lift my arms over my head and my pain is managed. During the pandemic when appointments were difficult (to say the least), Dr. Glaser and Maria held virtual visits with me so that they were able to keep my treatment consistent. But, to me the most important thing about Dr. Glaser and his staff is that I know they really care. They are kind, compassionate and let you know that they want to do whatever is necessary to help you. They take the time you need to go over how you're feeling and they try different treatments and various medications until they hit on the right combination that works for the individual. I highly recommend Dr. Glaser and the Pain Specialists of Great Chicago!