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
- 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 been under Dr. Glaser's care for well over 10 years and have had procedures + therapy to keep my back pain in check for most of the time. I typically would have an RF ablation done every 18-24 months combined with other injections. I had an ablation done this past June and it brought some relief but over the last year I had developed continual pain in my lower back that was not getting resolved. Dr Glaser introduced me to "Intracept" and, an MRI showed that I was a candidate for this procedure. I had the procedure done (outpatient) and I was completely functional later in the day. The recovery process was as expected, minimal discomfort (some incision pain) and over the next 2-3 weeks, little by little my lower back pain was completely eliminated. There is a wealth of information on Intracept and the great team at Boston Scientific provided great support throughout. Dr. Glaser has been able to keep me away from surgery and while I don't generally believe in silver bullets, this certainly feels like one. I can't say enough about Dr. Glaser and his team of professionals + the research he continually does on innovative new ways to help his patients. I highly recommend this to anyone who suffers from chronic lower back pain.
Dr. Glaser literally saved my husband’s life. Keith has had back pain for 55 years and countless surgeries on each level of his spine. Doctors have said his spine looked like a fun house. After seeing Dr. Glaser for years of pain, Dr. Glaser introduced my husband to the Intracept procedure. Keith had the Intracept procedure performed in August of 2025 and as of November, 2025, he is in no pain whatsoever. Dr. Glaser is Keith’s and my hero.
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