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
- ICC Form
- COVID 19 Consent to Treatment
- 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
- Notice of Privacy Practices
- Opioid Policy
- Controlled Substance Agreement
- Opioid Consent for Treatment
- Signature Sheet
- Benefit Assignment Policy
Patient Art states he has suffered from neck pain since he was a child, the pain became worse when he was involved in a car accident years later. Art has tried every avenue to relieve the pain; it was not until he was referred to Dr. Glaser who worked hard to find a plan that worked specifically for him. Art is not pain free but does say his pain is manageable and will continue to follow Dr. Glaser’s treatment plan. We thank Art for sharing his story!
Dr. Goodman can be described as our hero and a miracle worker. He was very encouraging with my mother and gave her to x-ray guided injections in her hip. After the first one she was able to bear weight and he prescribed physical therapy for her to get her leg strength back. After several months of physical therapy she is now able to ambulate in her apartment and within the retirement community where she lives. She is able to leave the community easily and attend family functions again - even going up two steps. You can now see the wheelchair is being used as her desk! Dr. Goodman also provided his input in the care plan meeting at the community and was very insistent on pushing my mom as far as she could go by encouraging everyone to limit the use of the wheelchair whenever possible. He gave my mom the confidence she needed to improve.