If you are an established patient and this is your first time booking on this system, please complete the form in its entirety.
PLEASE CHECK YOUR EMAIL FOR APPOINTMENT DETAILS AND CONFIRMATION AFTER SCHEDULING.
Mail me filter to your spam folder.
*ALL REQUIRED FORMS MUST BE COMPLETED PRIOR TO YOUR VISIT. YOUR VISIT WILL BE CANCELLED OR RESCHEDULED IF FORMS ARE NOT COMPLETED.*
SELF PAY FEES:
New Patient $227, Established Patient $127, Established Patient Refill $50
IMPORTANT NOTICE! Effective JUNE 1, 2025, ALL Telehealth appointments must be paid up front at the time of scheduling. Telehealth appointments can only be scheduled using my online scheduling system. You will receive a superbill to submit to your insurance for reimbursement.
This is a non traditional, non-medical treatment meeting with Dr. Bain. This is for those who are located outside of Dr. Bain's servicing areas or are looking for non-allopathic alternatives. This meeting will provide an opportunity to discuss clinical cases and issues which Dr. Alan F. Bain may have some expertise in that, Dr. Alan F. Bain may provide educational information or material regarding certain symptoms and diagnosis you are inquiring. This is not reimbursable with insurance.
Office Location: 444 N Northwest Hwy STE 200 Park Ridge, IL 60068 (312) 236-7010
Please bring your ID and insurance card. All copayments are due at check in. Outstanding balances must be paid in full or patient must be enrolled in a payment plan prior to visit.