Existing Patient - Pain Specialists of Greater Chicago

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.

Forms:

Patient Demographics
Signature Sheet
HIPAA Form
ARI 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)
New Patient Packet
Request Medical Records
Benefits Assignment Policy
Interventional Procedure Instructions
Credit Card Authorization Form
Patient Agreement for Controlled Substances
Release of Medical Records Form

Policies:

I have had lower back pain for years. Periodic steroid injections usually helped but the relief was not permanent. Dr. Glaser advised me of a new procedure called "Intracept Procedure". In March of 2025 Dr. Glaser performed the Intracept procedure on me. He said the full benefit of the procedure might take several months. On a recent visit to Dr. Glaser in July, I told him my lower back pain was gone. For someone who has chronic lower back pain, this procedure might be what you need.

Murray C

I have had arthritis back pain for many years. I had just about given up when I saw Dr. Glaser. After back injections....I feel like I have a new lease on life! It's unbelievable to be able to do normal things usually taken for granted like cleaning the house, cooking or even going to dinner with friends without being in debilitating pain. Thank you so much for helping me!

Teresa K