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​




  • Completed forms can be sent to our office by:

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

ALL VISITORS ARE REQUIRED TO WEAR A MASK. | If your insurance has changed please send us the updated insurance information before your next appointment. | Check below for our list of ongoing research studies.

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

​​Psychiatric Care and

Research Center

New Patient Forms:​​

Please print out and complete attached forms before your appointment.




Completed forms can be sent to office by:

    Fax: (636) 244-3594

    Email: info@pcrc-stl.com