New Patient Appointment Request

This request process is for new patients only.

If you have an urgent medical problem, do not use this form. If it is a life-threatening medical emergency, please go to an emergency room.

If you need to reschedule an existing appointment, please call Chicagoland Pain Management in Bolingbrook, IL at (630) 312-4505 in Bolingbrook or in Hinsdale, IL at (630) 856-6825 during our normal business hours.

After you submit your request, our appointment scheduler will respond within 48 hours. If you are a new patient, see below for forms to download, print, complete and bring with you to your appointment.

Patient Registration Forms

Chicagoland Pain Management Institute in Bolingbrook and Hinsdale, Illinois welcomes you to our practice. Once you have made your initial appointment, you may preregister by downloading, printing, and completing the registration form below. Doing so prior to your visit will help speed up the new patient registration process.

Please be sure to bring all forms with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by another physician.

Downloadable Forms:

• Patient Registration Form
• Credit Card Guidelines
• Office Guidelines

Please note:  It may take a few moments to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.