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Patient Forms

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  • Patient Forms + Policies
  • Patient Forms and Policies

For your convenience, you can now fill out your new patient forms at home. You can submit your completed forms by email, fax, mail, or in person prior to your visit. Please have all diagnostic imaging, surgical consultations, and prior pain management treatments sent to our office.

At Modern Pain Consultants, we will work closely with your referring doctor. We believe in a multidisciplinary approach to your treatment by combing our expertise with other medical specialties. If you have any questions, our staff will assist you with obtaining all pertinent medical documents.
Please fax documents to 708-482-4502.

Welcome to Modern Pain Consultants. We look forward to meeting you.

New Patients

New Patient Intake Paperwork

Controlled Substance Agreement

Pain Intake Questionnaire


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Modern Pain Consultants

The Premier Pain & Spine Specialists
    • Locations


      5201 Willow Springs, Suite 110
      LaGrange, Il 60525

      (708) 482-4500

      Silver Cross

      1890 Silver Cross Blvd., Suite 315
      Silver Cross Pavillion A
      New Lenox, Il 60451

      (815) 416-1224



      1802 Division, Suite 605
      Morris, Il 60450

      (815) 416-1224


      1100 E. Norris Drive
      Ottawa, Il 61350

      (815) 416-1224

    • Hours of Operation



      Monday - Friday:
      Every other Thursday:
      Weekends hours available upon request

      Morris & New Lenox

      Monday - Friday:
      Weekends hours available upon request


      Monday & Friday:
      Saturday & Sunday:


      8:00 AM - 6:00 PM
      8:00 AM - 7:00 PM

      8:00 AM - 4:00 PM


      9:00 AM - 3:00 PM