Participant Consent, Release and Acknowledgment
Posted on the site at /participant-consent. It sits next to your service agreement and the forms that Oregon rules require, and does not replace them. There is no name, date or signature field: by using this site or engaging with my services, you accept and acknowledge these terms.
Facilitator: Amy Charlesworth, licensed Oregon psilocybin facilitator.
1. What this is, and what it is not. I understand that Flight Guide offers preparation and integration coaching, focused on pattern breaking and pattern forming, along with licensed psilocybin facilitation. It is not therapy, counseling, medical treatment or mental health care. Amy Charlesworth is a licensed psilocybin facilitator, and that is the only license she holds for this work. She also has multiple trainings and certifications, and extensive study and practicum experience. She is not a therapist or medical professional and does not diagnose or treat any condition.
2. My own professionals. I have been told to talk with my physician, my medical team and my mental health provider before and during these services. I have done so, or I have chosen not to, and I understand that choice is mine.
3. My health disclosures. I understand I will complete the OHA OPS medical screening, health forms and consent forms before any session. I have answered every screening question honestly and completely, including my medications, medical and mental health history, family history, pregnancy status, and any substance use. I will tell Amy about any change before a session. I understand an incomplete answer can put my safety at risk, and that Amy may decline, pause or stop services if safety, compliance or conduct concerns arise.
4. Risks. I understand that psilocybin can cause strong physical and emotional effects, including fear, confusion, anxiety, nausea, raised heart rate and blood pressure, difficulty with time and reality, and difficult memories. Effects can last after a session and can include distress. It can interact with medications and conditions. I understand results are not guaranteed, and that benefits are not promised.
5. Voluntary and consent based. I take part by choice. I can ask questions, ask to pause, change anything, or stop at any time. Any touch or support is by my permission only, agreed beforehand, and I can withdraw it at any moment. I understand I may use or not use any tool or practice offered.
6. Safety. I will follow the safety agreements for my session, including staying in the service space until Amy confirms I am ready to leave, not driving, and arranging a safe ride and a place to rest afterward. I understand that if I am in danger or another person is, Amy may take steps she believes are needed for safety, including calling emergency services. If anyone is experiencing a medical emergency, we will call 911.
7. Confidentiality, mutual and strict. Amy keeps everything I share, and everything about the work we do together, in the strictest confidence. I agree to do the same for Amy and her business. This does not stop me from speaking with my own doctors, mental health providers or lawyers, from sharing my own experience, or from contacting or filing a complaint with the Oregon Health Authority. The only exceptions to Amy's confidentiality are those Oregon law allows (ORS 475A.450): when I consent; if I bring a legal action or complaint against Amy, Flight Guide or the service center; if I communicate a plan to commit a crime that would harm me or someone else; if something I say suggests a child may be the victim of a crime, abuse or neglect; when responding to an Oregon Health Authority investigation; and to report the data that OHA requires. In a group, I agree to keep other participants' names and stories private, and I understand Amy cannot guarantee what others do.
8. Assumption of risk and release. I have reviewed my rights and all of the consent forms provided to me. I knowingly and voluntarily accept the risks of taking part. To the fullest extent the law allows, I release and forever discharge Amy Charlesworth, Flight Guide LLC, the licensed service center where my services take place, and their owners, employees and contractors from all claims, known and unknown, arising from my participation, including claims of ordinary negligence, and I agree not to bring such a claim. I understand that any liability that remains is limited to the amount I actually paid under my service agreement. This release does not apply to gross negligence, willful misconduct or anything the law does not permit a person to release. It does not limit my rights under the Client Bill of Rights, and it does not stop me from contacting or filing a complaint with the Oregon Health Authority. I understand I am giving up legal rights and that I may talk with my own lawyer before signing.
9. Reviews and testimonials. I choose whether to post a review. If I do, I give permission to display the words I submit, under the name I choose, after Amy approves it. I may ask for removal at any time. Nothing is offered in exchange for a review. I will not include another person's information or health details.
10. Emails and texts. Joining emails or texts is optional, separate, and handled by the opt-in boxes on the website. Declining does not affect my services.
11. Privacy, payments, refunds, scheduling and recording. I have read the Privacy Policy and Terms of Use. I understand that prices are subject to change, that Flight Guide is not covered under HIPAA, and that services are not covered by insurance. I will receive fee documentation, before I pay anything, that states who receives each fee, the refund policy and any additional fees. I agree to the payment terms in my service agreement. Refunds are limited: if I cancel before any services begin, I may receive a refund of what I paid, provided I give written notice at least 7 days before my first scheduled session. After services begin, I may receive a partial refund for sessions not yet held, minus the value of any sessions already held or used, provided I give written notice at least 7 days before the scheduled session. In every other case, all payments are final. Where possible, Amy prefers to give credit on file toward future services, at her discretion. Because Amy holds booked time for me that she cannot rebook, credit on file expires 1 year after it is issued. I understand it is up to me to schedule and use every session included in my package. Amy is very flexible with rescheduling and will typically grant a one-time exception when plans change. If I do not show up for a session, I forfeit that session. Amy treats no-shows as unacceptable and will offer a new time only for a qualifying reason, meaning a genuine emergency involving death, life or limb. I will honor Amy's time as she honors mine, and I will give as much advance notice as I can. Amy does not record sessions. Under Oregon rules, a session may be recorded only with the prior written consent of everyone being recorded, and I may not record a session on my own devices.
Session length. I understand that sessions are booked in 60-minute blocks and include 50 minutes together with Amy. The last 10 minutes is protected time for me to take notes, do a short meditation and prepare for my next commitment, and Amy uses the same 10 minutes for herself.
Payment plans. I understand that any payment plan Amy offers is a genuine courtesy. Every payment is owed by the due date committed in writing by email. If I do not satisfy my payment plan, I understand Amy will pursue collection of the amount owed, including through a collections agency, to the fullest extent of the law, and that I am responsible for the reasonable costs of collection where the law permits.
12. The whole agreement. This is the full understanding on these topics. If a part is found unenforceable, the rest stays. Oregon law governs.
Acceptance. By using this site or engaging with my services, you accept and acknowledge these terms.