Resources
Oregon Psilocybin Services Client Forms
Official Oregon Health Authority forms and documents for Oregon psilocybin services.
This page links to Oregon Health Authority materials and does not collect or store completed forms. Visit the OHA Psilocybin Services page for more info.
Informed Consent
Explains the nature of Oregon psilocybin services, possible risks and benefits, client rights, service limits, and consent to participate.
Client Bill of Rights
Outlines client rights during Oregon psilocybin services, including dignity, privacy, informed consent, nondiscrimination, and reporting concerns.
Client Information Form
Collects client background information used to support preparation, planning, safety considerations, and service documentation.
Client Transportation Plan
Documents how the client will safely leave the service center after an administration session, including transportation and support details.
Client Safety and Support Plan
Identifies safety needs, support people, warning signs, and practical steps for helping the client before, during, and after services.
Client Medication and Medical/Assistive Device Form
Documents medications, medical conditions, assistive devices, and other considerations that may affect planning or support.
Interpreter or Client Support Person Plan
Used when an interpreter or support person may be involved, including their role, presence, boundaries, and responsibilities.
303 Client Data Form
Collects required client data for Oregon Psilocybin Services reporting and administrative documentation.
Authorization to Disclose Personal Identifiable Information
Allows the client to authorize disclosure of personally identifiable information to specified people or entities under stated conditions.
Notice and Opt-Out of Disclosure of De-Identified Data
Explains disclosure of de-identified client data and gives the client a way to opt out where applicable.
Client Consent for Others to Be Present During Session
Documents consent for another person to be present during an administration session, including who may attend and why.
Client Consent for Use of Supportive Touch During Administration Session
Documents whether the client consents to supportive touch during an administration session and clarifies boundaries around that support.
Psilocybin Product and End of Session Form
Documents psilocybin product information and end-of-session details related to the administration session.
Psilocybin Product Potency Information
Provides product potency information to help clients and facilitators understand psilocybin product strength and dosing information.
Client Consent for Video/Audio Recording of Individual Session
Documents consent for video or audio recording during an individual administration session, including recording-related permissions.
Client Consent for Video/Audio Recording of Group Session
Documents consent for video or audio recording during a group administration session, including group-session recording permissions.