If you want us to call you to schedule a consultation, please email your contact information to NewPatient@painchicago.com or complete the following form. We will make every effort to return your call that day and, if we are unable to, we will call before noon the next work day.
Please read and complete forms & policies and bring to your appointment. Please bring your insurance card with you also. Thank you.
Forms:
- Patient Demographics
- Financial Payment Policy
- HIPAA and ARI forms
- Pain Diagram
- Fax Request for Medical Records
- Card on File FAQs
Policies:
- Notice of Privacy Practices
- Opioid Policy
- Controlled Substance Agreement
- Opioid Consent for Treatment
- Signature Sheet
Dr Glaser has relieved much of my husband's pain, in his back and in his knees. I think he's a godsend!
I see Dr Goodman, he is fantastic and has given me hope again. He has done several procedures on me plus Dr Goodman and staff make you comfortable. He really spends alot of time with you and explaining your condition and plan of action. I highly recommend Dr Goodman!
Learn about our 72 Hour Commitment to your pain relief.
Latest News & Events
DR. Glaser – ASAC Physician Focus
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Ohio Society of Interventional Pain Physicians Annual Conference Agenda.
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First Annual Meeting of the Ohio Society of Interventional Pain Physicians
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