Oregon Psilocybin Services - Facilitator License

Renew a Facilitator License

All psilocybin license types have a one-year term, beginning on the date the license was first issued.

To ensure license continuity, you must submit a complete renewal application at least 60 days before your license expires. See OAR 333-333-4250.

• Renewal applications that are complete, submitted according to requirements, and submitted at least 60 days before the license expires will be considered timely under OPS rules. Licensees who submit timely applications may continue to operate on an expired license if OPS is unable to process the renewal application prior to the license expiration date. Incomplete renewal applications will not be considered timely unless they are made complete at least 60 days before the license expires. 

• Renewal applications that are submitted less than 60 days before the license expires will be considered untimely under OPS rules. Licensees who submit untimely applications are prohibited from continuing to operate on an expired license if OPS is unable to process the renewal application prior to the license expiration date. Licensees are prohibited from exercising license privileges on the date their license expires if OPS is unable to process their renewal application before the expiration date and the renewal application is untimely.

We encourage licensees to begin the renewal process as soon as the renewal window in TLC opens. The renewal window in TLC opens 120 days prior to your license expiration date.

For more information about completing the required annual license renewal application process, please read this Letter to OPS Licensees on Renewals and refer to the Facilitator License Renewal Application Guide below:

Facilitator License Renewal Application Guide for ONLINE applications

Background Check Information

Learn more about background checks:

Overview of the Background Check Process

C

onviction Reporting Guide

Social Equity Plan Information

Learn more about social equity plans:

 OPS Social Equity Plan Resources 

OPS Social Equity Evaluation Report Guidance for Licensees 

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 - 1.2.24

Client Bill of Rights - 1.2.24

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 – 1.2.24

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)  - 1.19.24

Client Bill of Rights (Spanish)  - 1.19.24

Client Information Form (Spanish)  - 12.27.22

Client Transportation Plan (Spanish)  - 12.27.22

Client Safety and Support Plan (Spanish)  - 10.13.23

Client Medication and Medical/Assistive Device Form (Spanish)  - 10.13.23

Interpreter or Client Support Person Plan (Spanish)  - 10.13.23

Authorization to Disclose Personal Identifiable Information (Spanish)  - 10.13.23

Notice and Opt-Out of Disclosure of De-Identified Data (Spanish)  - 10.13.23

Client Consent for Other Individuals to be Present During an Administration Session (Spanish) - 10.13.23

Client Consent for use of Supportive Touch During Administration Sessions (Spanish) - 10.13.23

Client Consent to Receive Secondary Dose of Psilocybin Product (Spanish) - 10.13.23

Client Consent for Video Recording of Individual Administration Session (Spanish) - 10.13.23

Client Consent for Video Recording of Group Administration Session (Spanish) - 10.13.23

Client Release from Administration Sessions (Spanish) - 10.13.23