Oregon Psilocybin Services - Facilitator License

Background Check Information

Learn more about background checks:

Overview of the Background Check Process

Social Equity Plan Information

Learn more about social equity plans:

 OPS Social Equity Plan Resources 

Operational Forms for Facilitator Licensees

Oregon Psilocybin Services (OPS) administrative rules require that licensees use certain forms and documents for the production of psilocybin products and the provision of psilocybin services. Please consult the rules to determine whether a form must be competed for every client or whether it must be completed only when certain conditions or events occur.

Please Note: To digitally sign documents, it is important to download and save the document to a computer, then open it in Adobe Reader to complete. It is recommended that the most current version of Acrobat Reader be used. Click here to get a free download of Adobe Reader. Individuals may need to create and save a new password-protected 'Digital ID' in Acrobat Reader in order to sign the forms digitally. OPS is unable to provide additional technology support.

Informed Consent - 12.27.22

Client Bill of Rights - 12.27.22

Client Information Form - 12.27.22

Client Transportation Plan - 12.27.22

Client Safety and Support Plan - 10.13.23

Client Medication and Medical/Assistive Device Form - 10.13.23

Interpreter or Client Support Person Plan - 10.13.23

Authorization to Disclose Personal Identifiable Information - 10.13.23

Notice and Opt-Out of Disclosure of De-Identified Data - 10.13.23

Client Consent for Other Individuals to Be Present During an Administration Session – 10.13.23

Client Consent for Use of Supportive Touch During Administration Session – 10.13.23

Client Consent to Receive Secondary Dose of Psilocybin Product – 10.13.23

Client Consent for Video and Audio Recording of Individual Administration Session – 10.13.23

Client Consent for Video and Audio Recording of Group Administration Session -10.13.23

Client Release from Administration Session – 10.13.23

Emergency Services Contact Report - 10.13.23

Adverse Reaction Requiring Medical Attention or Emergency Services – 10.13.23

Formas y documentos operativos del facilitador

Spanish versions of new and updated forms are currently being translated and will be posted as soon as they are available. 

Informed Consent (Spanish)  - 12.27.22

Client Bill of Rights (Spanish)  - 12.27.22

Client Information Form (Spanish)  - 12.27.22

Client Medication and Medical/Assistive Device Form (Spanish)  - 12.27.22

Interpreter or Client Support Person Plan (Spanish)  - 12.27.22

Authorization to Disclose Personal Identifiable Information (Spanish)  - 12.27.22

Notice and Opt-Out of Disclosure of De-Identified Data (Spanish)  - 12.27.22

Client Safety and Support Plan (Spanish)  - 12.27.22

Client Transportation Plan (Spanish)  - 12.27.22