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:
- Patient Demographics
- Signature Sheet
- HIPAA Form
- ARI Form
- Request for Release of Medical Records
- New Patient Packet
- Benefits Assignment Policy
- Interventional Procedure Instructions
- Credit Card Authorization Form
- Patient Agreement for Controlled Substances
Policies:
- Notice of Privacy Practices
- Opioid Policy
- Controlled Substance Agreement
- Opioid Consent for Treatment
- Controlled Substance Policy
From the kick off, I was very impressed as for his level of concern he had for me. Many ways to approach my problem, detailed AT MY LEVEL OF UNDERSTANDING! Explanation at first visit To my procedure, followup calling me to see how things were going. He cares and keeps one in the loop.
I want to share my great experience. I've been dealing with leg and back pain for at least 2 years. i was referred to Doctor Glaser, Maria and David. They are all pleasant, professional and they have your best interest in dealing with pain. They are so helpful and listen to you to determine the best way to put your pain under control. They take their time with you and don't rush the appointment. The staff that welcomes you is also very pleasant. I can't say "Thank You" enough to the doctor and his great staff....they are the best!
Learn about our 72 Hour Commitment to your pain relief.
Latest News & Events
Control Your Pain event; Summary
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