Emotional Support Animal Evaluation & Letter Request Form

Emotional Support Animal Evaluation & Letter Request Form

Client Name:*

Today's Date*

Clients DOB*

Clients Email Address*

Provider Name

Requested Due Date*

ESA Letters will be ready in three weeks. Should you need it sooner, we will speak with your provider to see if they can get it done any sooner. There is an additional fee for expedited letters.

Recipient Contact Information*

Please note who would be receiving your completed letter/evaluation such as your apartment building or external individuals. Please include names, address, and email or phone number.

Additional Notes

Have you spoken with your provider?*

Select or enter value

Veterinarian Information

Please note your veterinarian's name and practice information.

Animal to be assessed

Please list the type of animal and breed, if available, as well as the name and age of the animal.

Please note: if you do not have an animal yet, please come back to fill this request out once you do, as we do not begin the assessment process till you own an animal already.

Payment Option*

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