PATIENT RESOURCES

Preparing for a Clinic Visit

If you are a new patient, to best utilize time, you are encouraged to bring the enclosed forms completed with you to your appointment.

Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit.

Click the links below to open and/or print each document:

  1. New Patient Intake Form

  2. Financial Policy 

  3. Release of Records Authorization

What to bring with you to your Appointment

  • Picture ID

  • All Insurance Information

  • Required Referral Information or Letters as necessary

  • Any required Deductible / Co-Payments

Items to note before your Appointment

  • Having the appropriate forms filled out before your visit will reduce your total visit time.

  • Please allow for time to park; parking availability varies with each clinic location.

  • Clinic registration is done by appointment time. To decrease your overall waiting time, we recommend that you do not arrive more than 20 minutes prior to your appointment.

Cancellation Policy

If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours’ notice. This courtesy, on your part, will make it possible to give your appointment to another patient. There is a $100 cancellation fee for patients who miss appointment or do not provide 24-hour notice.

Insurance

At Chicago Institute for Neuropathic Pain, our roster of insurance plans and options is comprehensive. We accept Medicare, Worker’s Compensation, most HMOs, most PPOs, and many Liens. Every patient, regardless of their insurance type, receives the same efficient, effective and friendly service and medical care. 

Payment Options

For your convenience, we accept check and all major credit cards.