Get Started - Florida Pet ESA Letter

First Name

Last Name

Phone

Email

Which service are you interested in?

Emotional Support Animal Letter ($127 Fee)
Psychiatric Service Dog Letter ($127 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?

Yes
No

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)

Yes
No

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

Yes
No

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

Yes
No

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

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?

Yes
No

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

How did you hear about us?

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.

Initial Assessment

Meet Our Mental Health Specialist

About Jay