International Pain Specialists in Napperville, IL

Click to Call: 1-877-87DrJim

Sunday, February 23, 2020

Patient FormsPlease print and complete the following forms and bring them with you to your first consultation. The Health History and Registration forms should be completed prior to your appointment. Please read the authorization and policy forms and bring them withyou to be signed and witnessed in our office. 

The following form only needs to be printed and read if you have been referred for medication management.

This form is for the use of the Referring Physician's Office:

If you are having trouble opening these forms, please download a free copy of Adobe Reader available here

Work Related Injuries

We provide accurate diagnosis and prompt treatment. We work closely with case managers and claims adjusters to allow our patients a seamless return to work, with assignment to light duty as indicated.


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COOLIEF* Cooled Radiofrequency Treatment

 Coolief Cooled RF is a minimally-invasive, outpatient treatment that can safely treat chronic pain. This advanced procedure uses cooled radiofrequency energy to safely target the sensory nerves causing pain. Coolief circulates water through the device while heating nervous tissue to create a treatment area that is larger than conventional RF treatments. Read more...