ESA Letters Assessment

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3ESA Experience

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ESA Assessment

You are not alone! Nearly 1 in 5 US adults experience a mental illness in any given year, and almost half will experience one in their lifetime.

After you complete this 2 minute confidential self-assessment, we will pair you with a licensed healthcare professional who will review it with great care and empathy. Their evaluation will determine your ESA qualifications.

Note: Your answers are saved on our servers as you complete each question.

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Personal and Contact Information

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Date of Birth

Are you over 18 and not acting on behalf of anyone else?

Yes

Sorry, but you must be at least 18 years of age. We are unable to provide service to minors even if you’ve obtained your guardian’s consent. Thank you for your understanding.

Date of Birth*

Month

Day

Year

By adding your date of birth you confirm you are at least 18 years old and not acting on behalf of anyone else

Gender*

Male

Female

Non-binary

Other

Email*

Email Confirm Email

We will email you if, for any reason, you do not complete this questionnaire. You can unsubscribe from reminders at any time.

Please note: If you feel that you are in crisis, we implore you to reach out to the National Suicide Hotline at 800-273-TALK (800-273-8255), Crisis Textline text “HOME” to 741-741, or dial 911 in the event of a medical emergency.

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Your Emotional and Mental Self-Assessment

According to the National Alliance on Mental Illness, depression is a leading cause of disability worldwide.

Please let us know how depression and other emotional health factors have affected you.

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Mood Swings

How often have you been bothered by significant changes in your mood?*

Never

Rarely

A few days

More than half the time

Every day

Please indicate which of the following symptoms you have experienced in the past 6 months.*

Choose all that apply

Difficulty with focus and concentration

Irritability and/or agitation and/or anger

Fatigue

Restlessness

Changes in your sleep

?i.e., sleeping too much or difficulty falling asleep

Muscle tension

Depressed mood

Elated mood

Decreased interest in activities that you once enjoyed

Lack of motivation

Changes in your weight

?i.e., significant weight gain or weight loss

Changes in your appetite

?i.e., eating too much or too little

Feelings of worthlessness or hopelessness

Indecisiveness

Thoughts or wanting to hurt yourself or others

Difficulties with your activities of daily living

?e.g., preparing meals, paying bills, housekeeping, bathing

Missing work or school or performing poorly at work or school

Isolation or changes in your social functioning (i.e., not spending time with friends/family)

Other

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PTSD (Post-Traumatic and other Stress Disorders)

If you suffer from PTSD, how often do your emotions/symptoms bother you?*

Never

Rarely

A few days

More than half the time

Every day

Please indicate if you experienced any of the following symptoms in the past 6 months as a result of the traumatic event(s).*

Choose all that apply

Distressing dreams and/or memories of the traumatic event

Flashbacks

?i.e., feeling that the traumatic event is recurring

Avoidance of negative memories or thoughts associated with the event

Difficulty remembering important aspects of the traumatic event

Negative thoughts or beliefs about yourself and/or others

?e.g., “I am bad” or “I can’t trust anyone

Feeling detached or estranged from others

Difficulty experiencing positive emotions

?e.g., love, satisfaction, joy

Reckless or self-destructive behavior

Hypervigilance

Feeling easily startled

Other

Do the symptoms related to the traumatic event interfere with any major life activities?*

Major Life Activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

Yes

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Anxiety

On a typical day, how long do you feel anxious?*

Never

Less than 1 hour

1 – 3 hrs

3 – 5 hrs

5 hrs +

Please indicate if you have experienced any of the following symptoms in the past 6 months.*

Choose all that apply.

Increased heart rate

Uncontrollable shaking

Dizziness or nausea

Difficulty breathing

Hot flashes or profuse sweating

Numbness of extremities

?legs, fingers, toes, etc.

None of the above

Does your anxiety, worrying, panic attacks, or fear of future panic attacks interfere with any of your major life activities?*

Yes

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Depression

On a typical day, how long do you feel sad or depressed?*

Never

Less than 1 hour

1 – 3 hrs

3 – 5 hrs

5 hrs +

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Relay anything else

Please express anything else you'd like your licensed health professional to know about.

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Your ESA Experience

Did you know that patients recovering from hip replacement surgery required half as much pain medication when using a therapy dog?

You’re almost done! Please tell us about your ESA experience and what type you may benefit from the most.

Does the presence of an animal help alleviate symptoms of your emotional and/or mental health issues?*

Yes

How many ESAs do you need to help to alleviate your symptoms?*

4 +

At this time we are unable to assist requests for more than 3 Emotional Support Animals. If you’re willing to reduce the number of animals, please select your animals below.

Choose your preferred emotional support animal:*

Dog

Cat

Rabbit

Other

Please describe how your animal helps alleviate symptoms of your mental and/or emotional health issues.*

Choose your preferred emotional support animal:*

Dog

Cat

Rabbit

Other

Please describe how your animal helps alleviate symptoms of your mental and/or emotional health issues.*

Choose your preferred emotional support animal:*

Dog

Cat

Rabbit

Other

Please describe how your animal helps alleviate symptoms of your mental and/or emotional health issues.*

Note: per HUD guidelines, the LMHP we work with generally assist with dogs, cats, small birds, rabbits, hamsters, gerbils, other rodents, fish, turtles and other small, domesticated animals traditionally kept in the home for pleasure. We cannot assist with reptiles, barnyard animals, monkeys, and other non-domesticated animals not considered common household animals.

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Choose your options

ESA letters are compliant with federal FHA, HUD, and state regulations and are provided by licensed healthcare professionals on their official letterhead.

Which option do you prefer?*

Serenity

$399

Signed ESA letter on LHCP’s official letterhead

Assessment by a LHCP

Email delivery

Custom forms (digital delivery)

Discounted ($399 $199) auto-annual renewal

Priority Customer Care

Rejection Protection

Expedited service

$399 Membership

Advantage

$199

Signed ESA letter on LHCP’s official letterhead

Assessment by a LHCP

Email delivery

Custom forms (digital delivery)

Discounted ($199 $99) auto-annual renewal

$199 Membership

Essentials

$189+

Signed ESA letter on LHCP’s official letterhead

Assessment by a LHCP

Email delivery

Choose your add-ons

No subscription or discounted auto-annual renewal

Single Letter from $189

Discounted annual renewal — safeguard your qualifications

?ESA laws are constantly changing and requirements for new letter issuances may change. As a result, our prices for new letters may change. Automatically annually renewing your ESA letter at your subscription’s locked-in discounted price will keep your qualifications current. You may cancel at any time within the next year and before completing your renewal assessment.

Priority Customer Care — fast-tracked answers

?Are you nervous about presenting your letter to a housing provider who is difficult about accommodating pets? With decades of combined experience, our Customer Happiness Team has seen it all. Our top team members will prioritize your emails to help you refute any initial rejections your housing provider puts forward, which usually grants an accommodation. Please see our Terms and Conditions for exclusions and restrictions.

Rejection Protection — get peace of mind

?In the unlikely event that your housing provider ultimately violates your rights and rejects your ESA, we will refund your order, less a fee, to help compensate us for processing costs and your LHCP’s time. Please see our Terms and Conditions for more details including exclusions and restrictions.

Expedited service — meet time-sensitive deadlines

?Rush your digital delivery and your queue position to meet an immediate deadline. Please note that our LHCPs only work on business days.

Custom forms — for extra documentation

?Some housing providers and airlines request the submission of forms in addition to the ESA letter. These forms are handled by your LHCP and digitally delivered to you.

Notice regarding flights

?As a result of rule changes by the U.S. Department of Transportation, most airlines no longer accommodate ESAs. Please check with your airline directly prior to booking a flight to see their latest policy.

Choose your custom order add-ons

Pick which add-ons you would like to include in your custom order:

Rejection Protection +$99

Expedited service +$99

Custom forms (digital delivery) +$49

Rejection Protection +$99

Price:

Expedited service +$99

Price:

Custom forms (digital delivery) +$49

Price:

Total

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Residence and legal info

Is your ESA for On-Campus (Dorm) housing?*

If you are uncertain, please select “Yes,” and we will follow up with you.

Yes

Please note that some on-campus and university housing can be challenging to deal with their policies. They can impose certain requirements and request additional documents. Most of our clients with a valid ESA letter are successful — but some are not. We offer support and extra document services if needed but cannot process refunds if your university ultimately denies your request. Extra documents that are complex or require additional information are subject to review by your LHCP and may be subject to different fees. See our FAQ for more details.

Your place of residence and other legal information *

This is your full legal name, contact number, and the address where you will be residing with your ESA. It is important that your ESA letter is issued by a licensed health professional who is licensed for the state you and your ESA will live in.

First Name (Legal Name)*

Last Name*

Address*

State ZIP Code

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Might live in an Irvine Company owned apartment

Yes

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Might live in a MAA owned apartment

Yes

Phone Number*

How did you hear about us?

Choose all that apply

Local shelter

Referral

Other

Total

Payment Details*

Card Details

Cardholder Name

Consent*

I have read and agree to the Terms and Conditions and Privacy Policy*

Newsletter Consent

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ESA Assessment

Personal and Contact Information

Your Emotional and Mental Self-Assessment

Mood Swings

PTSD (Post-Traumatic and other Stress Disorders)

Anxiety

Depression

Relay anything else

Your ESA Experience

Choose your options

Residence and legal info

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