Step 1: Application Form Step 2: Consent Form Step 3: Confirmation

Personal Information

Tell us about yourself for your ESA letter

First Name

Last Name

Email Address

Phone Number

Important: A Texas Service Animals provider may contact you from a different phone number regarding your evaluation. Many phones automatically silence or block unknown calls and texts. Please temporarily allow unknown calls and text messages during the evaluation process to avoid delays.

Create Password *

Confirm Password *

Full Name

Letter Type

Preferred Contact Method

Date of Birth

City

State

Quick Scheduling Information

Required so your clinician can complete the phone evaluation.

To complete your evaluation, we'll do a brief phone call.

Please provide the best phone number and times that work for you.

Best Phone Number for Evaluation Call

How should we confirm and send reminders? How should we confirm and send reminders?

Preferred Times for Call Please list at least 2-3 time slots that work for you.

I understand the evaluation is completed by phone.

Pet Information

Tell us about your emotional support animal(s)

Primary Pet (Required)

Primary Pet Name

Pet Type

Pet Weight (lbs)

Pet Breed

Pet Sex

Pet Photo

Second Pet (Optional)

Pet Name (2)

Pet Type (2)

Pet Weight (lbs) (2)

Pet Breed (2)

Pet Sex (2)

Pet Photo (2)

Third Pet (Optional)

Pet Name (3)

Pet Type (3)

Pet Weight (lbs) (3)

Pet Breed (3)

Pet Sex (3)

Pet Photo (3)

PSD Training Information

Required details about your Psychiatric Service Dog's training

Mental Health Assessment

Standardized questionnaires to evaluate your mental health needs

PHQ-9 Depression Assessment

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

Feeling bad about yourself or that you are a failure

Trouble concentrating on things like reading or watching TV

Moving or speaking slowly, or being fidgety/restless

Thoughts that you would be better off dead or hurting yourself

GAD-7 Anxiety Assessment

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious, or on edge

Not being able to stop or control worrying

Worrying too much about different things

Trouble relaxing

Being so restless that it is hard to sit still

Becoming easily annoyed or irritable

Feeling afraid as if something awful might happen

Ready to Submit?

Review your information and proceed to the consent form

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Personal Information

Let's start with your basic information

First Name *

Last Name *

Email Address *

Phone Number *

Continue to Pet Information

Next, tell us about your emotional support animal

Pet Information

Tell us about your emotional support animal(s)

First Pet (Required)

Pet Name *

Pet Type *

Breed *

Weight (lbs) *

Sex *

Pet Photo

Do you have other pets?

Yes No

Second Pet (Optional)

Pet Name

Pet Type

Breed

Weight (lbs)

Sex

Pet Photo

Do you have a third pet?

Yes No

Third Pet (Optional)

Pet Name

Pet Type

Breed

Weight (lbs)

Sex

Pet Photo

Continue to Mental Health Screening

More than half
2

Nearly every day
3

Continue to Contact Preferences

Almost done! Tell us how to reach you

Contact Preferences

How would you like us to reach you?

Letter Type *

Preferred Contact Method *

Quick Scheduling Required

To complete your ESA evaluation, we’ll do a brief 10–15 minute phone call.

Please share the best number and a couple of times that work for you.

Phone Number for Scheduling *

Reminder Preference * How should we confirm and send reminders?

Availability for Phone Call * Please list at least 2 time slots that work for you

I understand the evaluation is completed by phone. *

Continue to Create Account

Final step: Secure your evaluation with a password

Create Your Account

Secure your evaluation with a password

Create Password * Minimum 6 characters

Confirm Password *

Ready to Submit?

Review your information and submit your evaluation

Your information is encrypted and HIPAA compliant

ESA Letter Application

Personal Information

Quick Scheduling Information

Pet Information

Primary Pet (Required)

Second Pet (Optional)

Third Pet (Optional)

PSD Training Information

Mental Health Assessment

PHQ-9 Depression Assessment

GAD-7 Anxiety Assessment

Ready to Submit?

Quick Scheduling Required

Email:

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