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
- Request for Release of Medical Records
- 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
Policies:
I was introduced to Dr. Glaser through a friend who highly recommended Dr. Glaser as the "Best Pain Specialist in Illinois" She stated "Dr. Glaser actually cared for you and listened to your pain situations." I was grateful for the recommendation, but I doubted her referral because I had visited so many other doctors who did not listen nor did they care when I complained of the pain areas in my body. As I do with all previous and current doctors - I searched his patient reviews and complaints - all good and there were no complaints. I suffered from severe pain in my entire body for 15+ years with excruciating pain extending from Lupus, Fibromyalgia, and Osteoarthritis combination. My value in life had simply diminished and I just wanted to die. I was so tired of being in pain every day. No social life. I could not work, and my marriage was deteriorating heading for divorce because I did not want to do anything but stay in bed and just suffer. After a while, staying in bed became too painful. I experienced so many years of suffering. People said that I was lazy and "imagining" the muscle pain in my muscles, knees, lumbar, tendons, and joints. One day - I decided to take my friend's advice and I contacted Dr. Glaser's office to set up an appointment for a new patient's initial consultation. Dr. Glaser's office accepted my health insurance (luckily.) His staff is very professional, friendly, and personable. I received an appointment the following week. Upon meeting Dr. Glaser his first impression was extremely professional and courteous. He shook my hand and introduced himself - which I thought was very uncommon in today's doctors. I was impressed with his bedside manner and patient hospitality. Dr. Glaser appears to be incredibly wise and smart; he knows if you are faking pain. Glaser allowed me time to explain my pain areas and we discussed a personal pain management plan that would work best for me. He looked directly into my eyes and appeared to care. I believe the first impression of an individual is everything. For me, I can see into a person's soul through their eyes. Dr. Glaser treated me as a person, not someone complaining of pain untruthfully. Dr. Glaser diagnosed my pain management plan through MRIs and other diagnostic tests. After reviewing all my testing, urine, and diagnosis results. Dr. Glaser immediately suggested a pain management plan designed just for me right away to help alleviate the pain in the areas complained. I followed every word of his pain management plan and trusted his plan suggestions, and my God - I am so glad I did! As a result, after only three to four weeks of visiting Dr. Glaser, and trusting his pain management method. I have gotten out of that dreadful miserable bed to look for part-time work online to get my life back that was stolen from me many years ago. I am now visiting my friends and family, walking my dogs daily with ease, and I am almost back to myself now that my pain is manageable or there is no pain, and I can have a social life. My marriage has gotten better. My husband tells me that I smile more now since visiting Dr. Glaser. I told him that when a person is in pain - they are irritable and have no reason to smile. This is the absolute truth. I don't know how many times I can say it - I am so grateful that I have my life back thanks to Dr. Glaser. It took me a long time to find a good, decent, caring pain specialist. Dr. Glaser comes highly recommended in my book. You will not be disappointed with Dr. Glaser. While I still do experience minor pain and aches in my legs and feet areas, although absolutely nothing like it was before. I believe in time if continuing to work with Dr. Glaser on his pain management plan this will soon improve. I strongly trust Dr. Glaser's pain techniques and pain recommendations. While I know that I will never be 100% pain-free because of my other auto-immune diagnosis. I believe having a pain management plan is most helpful in managing your pain so there are no restrictions on your life or livelihood. Dr. Glaser restored my social life and my marriage, and I am blessed and profoundly grateful to Dr. Glaser. Dr. Glaser is an old-school personality style doctor who does not have other individuals (strangers) in the room with you while you are discussing your pain and personal business. Dr. Glaser is respectful of his patients' needs and takes notes on his laptop. Dr. Glaser and his team keep records of each visit, so you do not have to repeat yourself over and over. I would like to say to Dr. Glaser - Thank you and your team for all you have done and are still doing for me! Again, thank you, thank you, and thank you!
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.
Learn about our 72 Hour Commitment to your pain relief.
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