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Board of Psychologist Examiners

OBPE FORMS
HOW TO REQUEST FORMS
The following forms are available for download at this website. Printed copies may be requested from the Oregon Board of Psychologist Examiners:
 
Oregon Board of Psychologist Examiners
3218 Pringle Road SE, Ste. 130
Salem, OR  97302
Phone:  503-378-4154
Fax:      503-378-4404
email:  oregon.bpe@state.or.us

CONSUMERS
Investigation Request Form - to make a complaint against a licensed psychologist, psychologist associate, psychologist applicant/resident, or a person who may be practicing psychology without a license. Inlcudes the records release authorization form.
 
List Request Form - to request a list of Oregon licensees/residents/applicants.

APPLICANTS & RESIDENTS
For application forms (including reference forms), please see Applying for Licensure.
 
For forms pertaining to residency, please see Residency.
 
For visitor's/temporary permit applicatin forms, please see Limited Permits.
 
Change of Name/Address - used to request change of name, address or email.
 
Interim Resident Evaluation
LICENSEES
Change of Name/Address - used to request change of name, address or email.  Also used to request a wall certificate or license reprint.
 
Continuing Education Tracking Tool - to maintain proof of continuing education completion.
 
Renewal Notice and Affidavit- a replacement for those who have misplaced their copy sent from the Board.
 
Diversity Form - optional.  The Board is required to collect this information regarding race, ethnicity, and languages spoken.
 
Reinstatement Application - for lapsed licenses- use this form if you are past 30 days but within 60 days of your renewal due date.
 
Reactivation Form - to request change from inactive status to active or semi-active status.
 
Application/License Information Request - to request copies of information from your file, including application, reference forms, exam scores, etc.
 
Qualified Designated Person Form - to designate a "qualified person" in case of death or incapacity of the licensee.  Required for all licensees.
 
Email Form - to sign up for email notifications.