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ESA LETTER

Apartment Housing & Air Travel ESA Letters $249

Apartment Housing ESA Letter $199

Air Travel ESA Letter $199


Letters are produced and emailed in pdf form, usually within 48-72 business hours.  Your assessment will be reviewed and a professional and he/she will reach out to schedule a video assessment to verify information entered and to complete a full evaluation. After the video assessment, the professional will make the decision to approve or deny your request. The professional has the right to decide whether further sessions are necessary in order to authorize your request.   Any denied request will be refunded. 


An emotional support animal (ESA) is a person’s pet that has been prescribed by a person’s licensed therapist, psychologist, or psychiatrist (any licensed mental health professional). The animal is part of the treatment program for this person and is designed to bring comfort and minimize the negative symptoms of the person’s emotional/psychological disability.


All types of domesticated animals can be Emotional Support Animals (cats, dog, and birds) and they can be any age (young puppies and kittens, too!). These animals do not need any specific task-training because their very presence mitigates the symptoms associated with a person’s psychological/emotional disability, unlike a working service dog. The only requirement is that the animal is manageable in public and does not create a nuisance in or around the home setting.


Once the below form is completed, You will receive an invoice by email.  The invoice must be paid in full to receive and appointment for your video assessment and your final ESA letter. 



ESA Letter Assessment Form

Name*

Date of Birth*

Email Address*

Phone Number*

What type of pet do you have?*

Select an option

What is your pet's name?*

Where are you most interested in taking your emotional support animal? (Select all that apply)*

Do you have health insurance*

Select an option

Have you ever been formally diagnosed with a mental health related condition by a medical professional? Examples include: anxiety, depression, PTSD, Bipolar Disorder, etc)*

Select an option

Has there been a major life event in the last year that has caused you great psychological stress?*

Select an option

Over the past two weeks, how often have you had little interest or pleasure in doing things?*

Select an option

Over the past two weeks, how often have you felt down, depressed, or hopeless*

Select an option

Over the past two weeks, how often have you felt more angry, grouchy, or irritated than usual*

Select an option

Over the past two weeks, have you been sleeping less than usaual, but still have a lot of energy?*

Select an option

Over the past two weeks, have you been starting more projects than usual or doing more risky things than usual?*

Select an option

Over the past two weeks, how often have you felt afraid or panicked?*

Select an option

Over the past two weeks, how often have you felt nervous, anxious, or on the edge*

Select an option

Over the past two weeks, have you experienced unexplained aches and pains?*

Select an option

Over the past two weeks, have you been feeling that your illnesses are not being taken seriously enough?*

Select an option

Over the past two weeks, have you had problems with sleep that has affected you overall sleep quallity?*

Select an option

Over the past two weeks, have you had unpleasant thoughts, urges, or images that repeatedly enter your mind?*

Select an option

Over the past two weeks have you felt driven to perform certain behaviors or mental act over and over again?*

Select an option

Over the past two weeks, have you been drinking at least 4 drinks of any kind of alcohol in a single day?*

Select an option

Over the past two weeks, have you smoked and cigarettes, a cigar, or pipe, or used chewing tobacco?*

Select an option

Over the past two weeks, have you ,issued by prescribed medications or taken medications which require a prescription, without a prescription?*

Select an option

Describe any significant life events that have contributed to your symptoms?*

Are you interested in enrolling in any of the following services with CHESS?*

Please describe your pet's temperament. Has your pet ever been aggressive? Does your pet make excessive noise? How does your pet assist in alleviating your symptoms?*

Do you currently or have you ever experienced any thoughts about harming yourself or others? If, yes please explain.*

Do you currently receive SSI or SSDI*

Select an option

What is the breed of your pet?*

Are you currently under the care of a psychiatrist? If yes, please provide the name.*

Do you experience any delusions or hallucinations? If yes, please explain.*

Have you ever had a mental health or physical health condition that could not be confirmed by a professional? For example, Do you believe that you have an illness, but a professional has performed testing that shows otherwise?*

Name of health insurance company?*


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