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 and a valid photo ID with you also. Thank you.
Forms:
- New Patient Packet
- Patient Demographics
- Signature Sheet
- HIPAA Form
- ARI Form
- Benefits Assignment Policy
- Interventional Procedure Instructions
- Credit Card Authorization Form
- Patient Agreement for Controlled Substances
- Release of Medical Records Form
Policies:
- Notice of Privacy Practices
- Opioid Policy
- Controlled Substance Agreement
- Opioid Consent for Treatment
- Controlled Substance Policy
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.
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!
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