Oregon Psilocybin Services Forms for Download

The State of Oregon encourages Clients to review the following forms to better understand information that may be covered with a licensed Facilitator in a Preparation Session. 

• Psilocybin Product Potency Information Document
• Informed Consent - 1.1.25
• Client Bill of Rights - 1.1.25
• Client Information Form - 1.1.25
• Client Transportation Plan - 12.27.22
• Client Safety and Support Plan - 1.1.25
• Client Medication and Medical/Assistive Device Form - 1.1.25
• Interpreter or Client Support Person Plan - 1.1.25
• Client 303 Data Form - 1.1.25
• Authorization to Disclose Personal Identifiable Information - 1.1.25
• Notice and Opt-Out of Disclosure of De-Identified Data - 1.1.25
• Client Consent for Other Individuals to Be Present During an Administration Session - 1.1.25
• Client Consent for Use of Supportive Touch During Administration Session  - 1.1.25
• Psilocybin Product and End of Session Form - 1.1.25
• Client Consent for Video and Audio Recording of Individual Administration Session - 1.1.25
• Client Consent for Video and Audio Recording of Group Administration Session - 1.1.25