ESA Letter Assessment Form

0/0 Complete

  • Introduction

  • General Information

    0/13

  • Purpose for Letter

    0/5

  • Personal Survey

    0/6

  • Symptoms

    0/27

The assessment form you will find in the next step is essential in determining whether you qualify for an ESA Letter.

Your answers will help us better understand your situation and determine if you are eligible for an ESA Letter. Please answer all questions honestly and to the best of your ability. By filling out the questionnaire, you could be one step closer to getting an ESA Letter and the benefits that come with it. Thank you for taking the time to fill out this form.

The form has 4 sections and will take about 5 minutes to complete!

personal information

Pet Information