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Emotional Support Animal (ESA) Evaluation

Please complete the questionnaire below to determine your eligibility for an emotional support animal letter.  
Birthday
Dia
Mês
Ano
Have you ever been diagnosed with a mental or emotional disability?
Yes
No
Are you currently seeing a licensed mental health professional?
Yes
No
Do you currently experience any of the following (check all that apply):
Have you ever used an emotional support (ESA) animal before?
Yes
No
Do you currently live in a rental property
Yes
No
If yes, does your landlord have pet restrictions
Yes
No
Do you intend to use your ESA letter for housing accommodations under the Fair Housing Act (FHA)?
Yes
No
Do you intend to use your ESA letter for travel accommodations under the Air Carrier Access Act (ACAA)?
Yes
No
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