Start Online Exam | Emotional Pet Support

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Patient First Name*
Human name only, NOT animal.
Patient Middle Name
Human name only, NOT animal.
Patient Last Name*
Human name only, NOT animal.
How many Pets
Pet #1 Type
Pet #1 Breed*
Pet #1 Weight
Pet #1 Name*
Pet #2 Type
Pet #2 Breed*
Pet #2 Weight
Pet #2 Name*
Pet #3 Type
Pet #3 Breed*
Pet #3 Weight
Pet #3 Name*

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Email Address*
Enter Email Confirm Email
Marital Status*
- Married
- Divorced
- Single
- Widowed
Gender*
- Male
- Female
Input your gender.
Birthdate*
MM slash DD slash YYYY

Enter your date of birth. Note: If you are under the age of 18 years old, the therapist might reach out for a parental consent release.
Phone (Cell Preferred)*
Input the best telephone number in case the therapist needs to reach you.
Attending a College/University?
The submit button has been disabled because we DO NOT support: living in a dormitory or college owned property.

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1) I am under high levels of Stress.*
2) I feel Overwhelmed by my current Life circumstances.*
3) I find myself feeling discouraged and pessimistic about my future.*
4) I find myself depressed and or saddened by my current life circumstances.*
5) I feel beat down and burnt out in my current life circumstances.*
6) I feel unhappy in my current life circumstances.*
7) I find myself worrying about my future, my finances, or my family.*
8) I feel frustrated and uneasy in my current life circumstances.*
9) I feel burdened by my current life circumstances.*
10) I find myself tense and up tight in my current life circumstances.*
11) My stress level is interfering with my work.*
12) My stress level is interfering with my sleep.*
13) My stress level is interfering with my ability to focus and concentrate on what I have to do.*
14) I turn to Alcohol, Food or drugs to comfort me in my current life circumstances.*
15) I am finding that Anxiety and restlessness are disrupting my everyday Lifestyle.*
16) I find myself irritable and often impatient in my current life circumstances.*
17) Do you find yourself lonely in your current life situation?*
18) Do you wish you had more and deeper emotional support systems?*
19) Does your stress level interfere with your communication with your loved ones, friends, or coworkers?*
20) I am subject to outbursts, Mood swings, or periods of negativity in my current life circumstances*
21) Which Life events have caused you significant stress this year?*

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Please describe your stress levels in detail.*
Have you ever seen a doctor for your emotional or mental health? Also, have you ever taken medication for your mental health?
How does your animal support you when you are experiencing anxiety, depression or other emotional issues? Please give specific examples.
Have you ever received a mental health diagnosis such as depression, anxiety, PTSD, etc.?
How does your mental or emotional disability directly impact your daily life and functioning?*
If you are requesting more than one animal, please describe in detail how each animal provides a uniquely distinct relief of symptoms of your mental disability.
PLEASE NOTE! This input will be added to your ESA letter only if you have two or more animals.

Examples below are what the therapist is looking for each animal:

Animal Name 1 Lifts my mood, and motivates me to complete daily life tasks to reduce anxiety.

Animal Name 2 Reduces isolation and provides comfort to reduce depression symptoms. My animal serves a distinct and necessary role in reducing my symptoms.

Animal Name 3 provides me with motivation, tactile comfort, and mood regulation support to complete activities of daily living to mitigate symptoms related to my diagnosis.
Please describe in detail how your animal provides a uniquely distinct relief of symptoms of your mental disability.

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Pick Your Plan*
- ESA Housing Letter
- PSD Air Travel Letter
- ESA Housing Letter & PSD Air Travel Letter
Regarding Air Travel Only: Please steer clear of airlines that demand a high level of training for service dogs: Aeromexico, Alaska Airlines, Allegiant Airlines, Air Canada, British Airlines, JetBlue, Lufthansa, or Sun Country. The rest of the 300 plus airlines welcome PSDs without any hassle.
Sub Total Cost
$0.00
Next, pick your options...
Hard Copy of ESA Letter to be Mailed via USPS
- No
- ESA Letter Only USPS Standard
- ESA Letter Only USPS PRIORITY w/Tracking
- ID Card & ESA Letter PRIORITY w/Tracking
The PSD letter is now included with this option if purchased.

Digital Delivery: All letters and certificates will be email to you regardless of any shipment options selected. Also, digital copies of ordered ID card(s) can be requested for free after receiving your exam approval email.

Note: Hardcopy letters and certificates are printed on special parchment 24 lb. weighted paper

The durable optional Photo ID card is made from the same plastic material as your common credit card.

The file uploader box will display below only if you select the ID card option. Email support@emotionalpetsupport.com only if you wish to send photos of your animal later.
Select type of ID card for Animal 1
ESA ID cards are for housing (ALL ANIMALS).
PSD ID cards are for housing and air travel (ONLY DOGS).
Select type of ID card for Animal 2
ESA ID cards are for housing (ALL ANIMALS).
PSD ID cards are for housing and air travel (ONLY DOGS).
Select type of ID card for Animal 3
ESA ID cards are for housing (ALL ANIMALS).
PSD ID cards are for housing and air travel (ONLY DOGS).
Upload a Photo for each animal.
Drop files here or
Max. file size: 256 MB, Max. files: 5.
Please allow time to upload your photo(s) before submitting the exam.

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Additional Housing Form
- Reasonable Accommodation Form
Optional service only to be used if your landlord has their own special form that needs to be filled out by one of our mental health professionals (RAF = Reasonable Accommodation Form). You can always request this option later in the future if you're not sure.

Note: We are in compliance with the Pet Screening verification services. On occasions, the provided letter requires slight editing, if requested by your landlord or Pet Screening.
Emotional Support Animal Certificate
- ESA Cert Emailed PDF + Mailed Via USPS
This ESA Certificate is only recommended for apartment/housing use.
Psychiatric Service Dog Certificate
- PSD Cert Emailed PDF + Mailed Via USPS
This PSD (Psychiatric Service Dog) Certificates is only recommended for air travel.
Rush Option*
Optional review timeframe. If not in a rush and can wait a few days for the review process, then skip this option. If you require a same day rush to have your exam reviewed and processed, then select the "6 to 12 hour" option above.

Note: Our therapists review cases 24/7 - 365 days a year. We do our best to provide your digital letters, ID cards, and certs within the selected timeframe.
Dog Training Options
Full Online Training ($59): This optional online training class is recommended for emotional support dogs and/or psychiatric support dogs. Either at home, flying, or in public places, we recommend that your dog be properly trained for all environments. After you have been approved by one of our mental health professionals, a link to the online video training class will be emailed. At the end of the dog training class (passing each session successfully), you simply upload a video of your dog responding to the required commands for which your assigned dog trainer will review. If no feedback is required, the dog trainer will approve and share their contact information. Note: The DOT form for PSDs is also covered with this option for those planning to fly with their dog and require that the DOT form include the dog trainer’s information.

Six Major Benefits of Dog Training
• It is significantly safer for your dog.
• It's safer for your home.
• It builds a lasting relationship between you and your dog.
• It's easier when you take your dog out in public.
• It's easier for the vet to work with your dog.
• You can help other dog owners.

Video Courses include:
1. Creating a bond between you and your dog.
2. Prepares your dog to pay attention to future commands.
3. Teach your dog to sit.
4. Teach your dog to lie down.
5. Teach your dog to heel.

PSD for Air travel Only ($29): If this option is selected and your dog is already trained, you will be asked to email or upload a video of your dog responding to basic commands (sit, stay or wait, come, and stop) after your exam has been approved. This will help ensure that your dog meets the requirements to be considered as a Psychiatric Service Dog (PSD) and DOT (Department of Transportation) form. Afterwards, your assigned trainer will provide all required DOT contact information so you can complete the DOT form.

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Comments / Special Instructions
Please write any additional comments or instructions within this box.
Billing Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address Different?
- Select this option if your shipping address is different from your billing address
NOTE: We no longer ship internationally.
Shipping Address
Street Address Address Line 2 City State ZIP Code

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THIS ONLY APPLIES IF YOU HAVE A DOG THAT NEEDS TO TRAVEL WITHIN THE CABIN OF AN AIRPLANE.
DOT (Department of Transportation) allows Psychiatric Service Dogs (PSD) to travel onboard airplanes. Please review the Training Checklist below:

Your dog does NOT engage in any of the following:
1) Growling or inappropriate, excessive barking
2) Nipping or biting
3) Showing or baring teeth
4) Lunging at other people or dogs
5) Being out of handler’s control
6) Inappropriately eliminating (urinating or defecating)
7) Enters and exits any form of transportation in a safe manner.
8) Is able to travel in any form of transportation in a controlled manner. Note: We currently do not support the following airlines: Aeromexico, Alaska Airlines, Allegiant Airlines, Air Canada, British Airlines, JetBlue, or Lufthansa as they only allow service dogs for physically disable people..
I attest to all above statements to be true. ONLY FOR DOGS
- I AGREE
Skip this if you don't have a dog.
Signature
By signing this form, the applicant is affirming or swearing that all information contained in the form is true and correct. Patient agrees to decline video sessions but can request the optional video session if so desired. This optional service can be requested with an additional fee of $95 per session.

Note: If you are unable to sign it now, we will follow up with you later.

Types of licenses: D.O. (Doctor of Osteopathic Medicine), LCSW (Licensed clinical social worker), LPC (Licensed professional counselor), MA (Master of Arts in counseling), MD (Medical doctor), MFT (Marriage and Family Therapist), and MHC (Mental health counselor).

By creating an Account, you agree that the Services may send you text (SMS) messages as part of the normal business operation of your use of the Services You may opt-out of receiving text (SMS) messages from EPS at any time contacting us at support@emotionalpetsupport.com. You acknowledge that opting out of receiving text (SMS) messages may impact your use of the Services.
Patient Consent To The Use of TeleHealth*
- I agree with the statement
I have read and understand the information provided regarding TeleHealth (tele-psychology/tele-medicine), I agree to share my information with my assigned mental health professional per the HIPAA privacy rights. I hereby give my informed consent for the use of TeleHealth (tele-psychology/tele-medicine) in my care. CLICK HERE TO VIEW CONSENT FORM I confirm that this/these animal(s) has been trained to behave in a public setting and takes my direction upon command. I assume full responsibility for the behavior of this/these animal(s), including its interaction with others. I also understand that I accept all liability to any damages resulting from any misbehavior by my animal(s).
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Regarding Air Travel Only: Please steer clear of airlines that demand a high level of training for service dogs: Aeromexico, Alaska Airlines, Allegiant Airlines, Air Canada, British Airlines, JetBlue, Lufthansa, or Sun Country. The rest of the 300 plus airlines welcome PSDs without any hassle.

Next, pick your options...