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ESA Letter form
Please complete this
short and simple
questionnaire
YOUR PET:
How many pets do you have?
1
2
3
No pets yet, but I will be getting one soon
Pet’s Sex:
Male
Female
What type of pet do you have?
Dog
Cat
Other
Other
Pet’s breed:
Pet’s Name:
Does your pet help improve your well-being?
Yes
No
PET OWNER:
First Name:
*
Last Name:
*
Email Address:
*
Confirm Email Address:
*
Sex:
Male
Female
Phone Number:
*
*Input the best telephone number for your Licensed Therapist to reach you
Date of Birth:
State of Residence:
Do you have difficulties coping with any of the following conditions?Â
Anxiety
Attention-Deficit/Hyperactivity Disorder (ADHD)
Depression
Substance Abuse Disorder
Emotionally Overwhelmed
Mood Disorder
Panic Attacks
Bipolar Disorder
Social Phobia
Autism
Stress Problems
Eating Disorders
Post-Traumatic Stress Disorder (PTSD)
Personality Disorder
Obsessive-Compulsive Disorder (OCD)
Medical Conditions:
Medical Conditions:
Other Mental Health Conditions:
Other Mental Health Conditions:
If you are human, leave this field blank.
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About Us
ESA Letter
PSD Letter
Pricing
FAQ
Contact
About Us
ESA Letter
PSD Letter
Pricing
FAQ
Contact
Terms & Conditions
Payment Options
Contacts
(305) 587-0025
support@officialesapets.com
Official Pets offers legally recognized ESA and PSD Letters to pet owners across the United States.
About Us
ESA Letter
PSD Letter
Pricing
FAQ
Contact
About Us
ESA Letter
PSD Letter
Pricing
FAQ
Contact
Terms & Conditions
Payment Options
Contacts
(305) 587-0025
support@officialesapets.com
Official Pets offers legally recognized ESA and PSD Letters to pet owners across the United States.
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