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Schedule an Appointment 

Please call our main office at
847-289-8822 to schedule an appointment at any of our locations.
 
If you prefer, you can complete the appointment request form below. When the form is complete, simply click the Submit button to send it to us.
 
Our scheduling coordinator will contact you to confirm your appointment. Please do not use this form to cancel or change an existing appointment. 
 
Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.
 

For Your First Visit with the Illinois Pain Institute

You may click on the links below to open any of the forms listed. Once opened, you can fill out the form on your computer, print a copy and bring it with you for your appointment.
 
In Lieu of Calling for an Appointment You may Fill out the Form Below

Full Name: 
Telephone: 
Email:
Please describe the nature of your appointment: 
Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.
Preferred time(s) for an appointment? : 
Preferred Location:
Lake Barrington, Elgin, McHenry, Itasca, Libertyville, Huntley

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