Informed Consent for Telehealth Services:​

Please print out and complete attached form before your virtual appointment with our providers:

  • Dr. Canale
  • Dr. Ilivicky
  • Kelly Govro, MMS, PA-C
  • Jan Chartrand, RN, M.Ed., LCSW, LPC, NCC​



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    Completed forms can be sent to our office by:

        Fax: (636) 244-3594
        Email:     info@pcrc-stl.com

Office Updates:

Front Desk: (636) 244-3589 | Research: (636) 244-3593 | Fax: (636) 244-3594
Address: 4132 Keaton Crossing Blvd, Ste. 201, O'Fallon, MO 63368

Please update your insurance information with our office at your next visit. | Check below for our list of ongoing research studies.

New Patient Forms:​​

Please use the link below to complete our New Patient Survey.






Completed forms can be sent to office by:

    Fax: (636) 244-3594

    Email: newpatient@pcrc-stl.com

​​​​Psychiatric Care and

Research Center