You can open the Emotional Support Animal Letter Template in multiple formats, including PDF, Word, and Google Docs.
Emotional Support Animal ESA Letter Template Printable | Editable FormSample
Examples
[Name of the Mental Health Professional]
[License Number]
[Professional’s Address]
[Professional’s Phone]
[Professional’s Email]
[Name of the Client]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Date of Issue]
Emotional Support Animal Letter for [Client’s Name].
This letter serves as a formal recommendation for an emotional support animal (ESA) for [Client’s Name], who I have been treating as a licensed mental health professional. [Client’s Name] suffers from [describe mental health condition], which significantly limits their ability to function in daily life.
It has been determined that an emotional support animal is necessary for [Client’s Name] to cope with their mental health challenges. The presence of an ESA will provide emotional support, alleviate symptoms, and assist in their recovery process.
The recommended emotional support animal is a [Type of Animal, e.g., dog/cat], named [Animal’s Name]. This animal has been determined to provide the necessary support for [Client’s Name].
As per the Fair Housing Act and Section 504 of the Rehabilitation Act, [Client’s Name] is entitled to have their emotional support animal with them in housing situations that may otherwise restrict pets.
This recommendation is valid for a duration of [specify duration, e.g., 1 year] and must be renewed upon reassessment. The ESA should not cause disturbances or pose a threat to others.
[Signature of the Mental Health Professional]
[Name of the Mental Health Professional]
[Title/Certification]
[Name of the Licensed Therapist]
[License Number]
[Therapist’s Address]
[Therapist’s Phone]
[Therapist’s Email]
[Name of the Patient]
[Patient’s Address]
[Patient’s Phone]
[Patient’s Email]
[Date of Issue]
Emotional Support Animal Recommendation for [Patient’s Name].
This letter is intended to certify that [Patient’s Name] has been under my care since [Date of First Appointment] and has been diagnosed with [specific mental health conditions]. It is my professional opinion that the presence of an emotional support animal is a crucial component of their treatment plan.
The emotional support animal is recommended to provide comfort and support to [Patient’s Name], which will help mitigate the symptoms associated with their condition, including [list symptoms].
The emotional support animal is identified as a [Type of Animal, e.g., dog/cat], named [Animal’s Name]. This animal is well-suited to assist them in their daily activities and emotional struggles.
According to the Fair Housing Amendments, [Patient’s Name] has the right to live with their emotional support animal in housing situations without any pet restrictions.
This letter is valid for [specify duration, e.g., 1 year]. Re-evaluation will be necessary at the expiration of this period to continue the necessity for an ESA.
[Signature of the Licensed Therapist]
[Name of the Licensed Therapist]
[Title/Certification]
Format
Please complete the form below to create the Emotional Support Animal (ESA) Letter Template. All fields must be filled out to ensure a properly formatted and valid letter. We provide examples to guide you through each step. Emotional Support Animal Letter Template 1. Provider Information 2. Patient Information 3. ESA Details 4. Emotional Support Reason 5. Recommendations 6. Limitations and Responsibilities 7. Signature and Date
PDF
WORD
Google Docs
Emotional Support Animal ESA Letter Template Printable | Editable FormPrintable
