Forms to complete prior to visit

Psychiatric Services of Southern Illinois

Please print and complete these forms before your first visit”

Medication Management Packet
“Please print and complete these forms before your first visit”

Print Packet PDF

Counselors Packet
“Please print and complete these forms before your first visit”

Print Packet PDF

Contact Us

For more information or to schedule an appointment, please contact Dr. Jeffrey S. Chalfant's psychiatry practice. We are here to assist you with any inquiries you may have.

Phone: (618) 236-6501

Address: 2900 Frank Scott Parkway W. Ste 990
Belleville, IL 62220

Skip to content