Initial Assessment

Continue with the Full ESA/PSD Questionnaire Below

- Step 1 of 5

First Name *

Last Name *

Phone *

Email *

Which service are you interested in? *

Emotional Support Animal Letter ($99 Fee)
Psychiatric Service Dog Letter ($99 Fee)

*There is no cost to take our evaluation! You may have the option to purchase a PSD or ESA letter if you are approved. Call Jay Charboneau if you have any questions: (727) 344-9930

I confirm that I am at least 18 years of age and not acting on behalf or another party *

Yes I confirm that I am at least 18 years of age and not acting on behalf or another party.
No I cannot confirm that I am at least 18 years of age and not acting on behalf or another party.

Are you filling this out on behalf of a minor child? *

Minors Full Name and Age

Relationship to the Minor Child

What type of pet do you have?

Dog
Cat
Other

What is your pets name?

Have you ever been diagnosed with a mental health condition by a medical / mental health professional? (IE: Depression, Anxiety, Post traumatic stress disorder, Bi Polar disorder)

Have you taken medication currently / or in the past to treat a mental health disorder *

In the past year has there been a major life event that has caused you psychological distress? *

During the past 6 months:

I was bothered by things that usually don’t bother me..
I did not feel like eating; my appetite was poor.
I felt that I could not shake off the blues even with help from my family or friends
I felt I was just as good as other people
I had trouble keeping my mind on what I was doing
I felt depressed.
I felt that everything I did was an effort.
I felt hopeful about the future.
I thought my life had been a failure.
I felt fearful.
My sleep was restless
I was happy.
I talked less than usual.
I felt lonely.
People were unfriendly.
I enjoyed life.
I had crying spells.
I felt sad
I felt that people dislike me.
I could not get “going.”
N/A

During the past 6 months:

I was bothered by an anxious mood: Worries, anticipation of the worst, fearful anticipation, irritability
I was bothered by Tension: Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.
I was bothered by Fears: Of dark, of strangers, of being left alone, of animals, of traffic, of crowds
I was bothered by Insomnia: Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors
I have had Difficulty in concentration, poor memory
I was bothered by somatic issues: Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
I was bothered by sensory issues: Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
I have been bothered by Cardiovascular issues: Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
I have been bothered by respiratory symptoms: Pressure or constriction in chest, choking feelings, sighing, dyspnea
I have been bothered by gastrointestinal issues: Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.
I have been bothered by Genitourinary symptoms: Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.
I have been bothered by Autonomic symptoms: Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.
I have been bothered by Behavior issues: Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc
N/A

Is there anything else you would like to share with the licensed professional?

During the past 6 months:

You felt so good or so hyper that other people thought you were not your normal self, or you were so hyper that you got into trouble.
You were so irritable that you shouted at people or started fights or arguments.
You felt much more self-confident than usual.
You got much less sleep than usual and found you didn’t really miss it.
You were much more talkative or spoke faster than usual.
Thoughts raced through your head or you couldn’t slow your mind down.
You were so easily distracted by things around you that you had trouble concentrating or staying on track.
You had much more energy than usual.
You were much more active or did many more things than usual.
You were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night.
You were much more interested in sex than usual.
You did things that were unusual for you or that other people might have thought were excessive, foolish, or risky.
Spending money got you or your family in trouble.
Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?

During the past 6 months:

Repeated, disturbing, and unwanted memories of the stressful experience?
Repeated, disturbing dreams of the stressful experience?
Suddenly feeling or acting as if the stressful experience were happening again (as if you were actually back there reliving it)?
Feeling very upset when something reminded you of the stressful experience?
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
Avoiding memories, thoughts, or feelings related to the stressful experience?
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
Trouble remembering important parts of the stressful experience?
Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
Blaming yourself or someone else for the stressful experience or what happened after it?
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
Loss of interest in activities that you used to enjoy?
Feeling distant or cut off from other people?
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
Irritable behavior, angry outbursts, or acting aggressively?
Taking too many risks or doing things that could cause you harm?
Being “super alert” or watchful or on guard? 18. Feeling jumpy or easily startled?
Having difficulty concentrating?
Trouble falling or staying asleep?

Is there anything else you would like to share with the licensed professional? (copy)

Does your animal assist you in coping with your emotional or mental health symptoms? *

Is there anything else you would like to add about your current mental health issues / symptoms?

Phone

How did you hear about us? *

Past Customer Name

If other, please explain.

Would you prefer to speak with the mental health specialist assigned to you and your dog before receiving the letter? *

Yes
No - Get letter now

What type of breed is your pet?

What is the age of your pet?

Address (This is where your ESA/PSD ID Card will be mailed to.)

Address Line 1

Address Line 2

City

State

Zip Code

Picture of Your Pet

Click or drag a file to this area to upload.

Please upload a picture of your pet. This image will be used on your certification card.

Meet Our Mental Health Specialist

Jay Charboneau MS, LMHC, CAP

Licensed Mental Health Counselor - MH15843 
Issue Date - 03/26/2018
Renewal Date – 03/31/2025 
Phone Number: (727)344-9930
Email: [email protected]

About Jay

Hi, I am Jay Charboneau. I live, work, and practice in Saint Petersburg Florida. I am an educator and lifelong advocate of the rights of those suffering from mental health disorders. As a dog lover myself, I understand the emotionally soothing and healing benefits of having your pet with you. Don’t hesitate to call me if you have any questions about your mental health or an emotional support animal.

Kimberly Petrollese, FL

Jay responds timely and is very helpful throughout the whole process. I recommend 10/10!

Danna Sullivan, FL

I recommend Florida Pet ESA! Dr Jay is very nice & helpful. He made it very easy.

Edwin Pabon, FL

Jay is extremely helpful in the process of making my baby a service dog. Thank you, Jay!

Susan Dolan DeVellis, FL

Jay is the most understanding and comforting therapist . When dealing with anxiety and depression , then being bullied by HOA board members , feeling hopeless, Jay explained the laws and help me understand so I could confidently communicate my situation. My ESA and I now live comfortably in my community.

Martha Nunez, FL

Professional affordable Reliable fast

Todd Joseph Whitley, FL

Thank you Jay. Your service has enabled me to have a my dog as an emotional support animal. Jay is reliable with getting back to contact with me when I reach out to his office

Garcia Kenny, FL

Recommended 100%. Jay is an excellent therapist, his professionalism and help through every process it’s much appreciated.

Mara Rosario, FL

I recommend it, it was a great help for my baby LuNna and I agree with it

100% Service

Gustavus Robert Gray III, FL

I found website easy to use. I got quick response, and I it has a phone number available to get answers to questions or concerns. I found great response and action from Jay Carboneau, their Mental Health Specialist. I got my letter of acceptance to be used as legal Emotional Support Document in a timely manner. I appreciated the ability to talk to a person rather than only using e-mails. It was very reassuring in the process.

Kimberly Villanueva Perez, FL

I recommend Florida Pet ESA 10000%. Jay has help me with my mental health but also helped me keep my fur baby with me in my new apartment. Good communication and fast respond 100% Thank you Jay!

Anna Molinaro, FL

I highly recommend Florida Pet ESA! Jay was profoundly responsive and compassionate. I felt prioritized and supported throughout the seamless process. Thank you!!

Rhianna Gail Harless, FL

Thank you so much, Jay. My fur babies are finally ESA-approved, and I can keep them wherever I go. I highly recommend Jay.

Kira N Lopez U, FL

AWESOME AND FAST SERVICE!!! I recommend them 100%!! Communication and response is great! They sent me the letter almost right away, even sent me the airlines form. I can’t believe they made it so easy, it was giving me anxiety just to think the doctor was going to judge me.

They went beyond expectations helping me

Vicki DeGrassa, FL

Very easy to complete paperwork. He was available via text or phone call. Received my letter within hours of applying. Highly recommend.

Tay Pendleton, FL

I requested an ESA and PSD letter. I received them very quickly. There was a small accidental typo that was corrected immediately. Great communication, easy process. If you need this type of letter this is definitely the place to go!

Diani Celis, FL

We are Spanish-speaking, and they serve us very well anyway. They resolved our doubts. Thank you very much!

Unknown, FL

Jay is a complete life saver! He helped me get my ESA letter in less than 24 hours! He also went completely above and beyond to make sure everything was in order for me. He is super open and honest and a delight to talk to. He’s definitely the person to go to if you need a ESA letter. 100/10 an awesome service !!

Kimberly Petrollese, FL

Jay responds timely and is very helpful throughout the whole process. I recommend 10/10!

Danna Sullivan, FL

I recommend Florida Pet ESA! Dr Jay is very nice & helpful. He made it very easy.

Edwin Pabon, FL

Jay is extremely helpful in the process of making my baby a service dog. Thank you, Jay!

Susan Dolan DeVellis, FL

Martha Nunez, FL

Professional affordable Reliable fast

Todd Joseph Whitley, FL

Thank you Jay. Your service has enabled me to have a my dog as an emotional support animal. Jay is reliable with getting back to contact with me when I reach out to his office

Garcia Kenny, FL

Recommended 100%. Jay is an excellent therapist, his professionalism and help through every process it’s much appreciated.

Mara Rosario, FL

I recommend it, it was a great help for my baby LuNna and I agree with it

100% Service

Gustavus Robert Gray III, FL

Kimberly Villanueva Perez, FL

I recommend Florida Pet ESA 10000%. Jay has help me with my mental health but also helped me keep my fur baby with me in my new apartment. Good communication and fast respond 100% Thank you Jay!

Anna Molinaro, FL

I highly recommend Florida Pet ESA! Jay was profoundly responsive and compassionate. I felt prioritized and supported throughout the seamless process. Thank you!!

Rhianna Gail Harless, FL

Thank you so much, Jay. My fur babies are finally ESA-approved, and I can keep them wherever I go. I highly recommend Jay.

Kira N Lopez U, FL

They went beyond expectations helping me

Vicki DeGrassa, FL

Very easy to complete paperwork. He was available via text or phone call. Received my letter within hours of applying. Highly recommend.

Tay Pendleton, FL

Diani Celis, FL

We are Spanish-speaking, and they serve us very well anyway. They resolved our doubts. Thank you very much!