ESA Step 1 (Qualifying Questionnaire)

1
Over the past 2 months, how often have you felt depressed, sad or hopeless?* This field is required.
Never
Rarely
Sometimes
Often
Always
2
Over the past 2 months, how often have you had less interest or pleasure in doing the things that you usually enjoyed?* This field is required.
Never
Rarely
Sometimes
Often
Always
3
Do you often become tired easily or experience a sudden unexplained loss of energy?* This field is required.
YESNO
4
During the past 2 months, have you been frequently worried or anxious about big or small events in your life?* This field is required.
YESNO
5
Over the past 2 months, how often have you felt more worried, anxious or "on-the-edge" than usual?
Never
Rarely
Sometimes
Often
Always
6
Have you ever felt afraid or had a panic attack because of your worrying or anxiety?
YESNO
7
Does worrying or anxiety interfere with your daily life activities?
All the time
Sometimes
Never
8
Please select which daily life activity is effected by your worrying or your anxiety.You may select more than one response.
Daily care
Performing manual tasks
Seeing
Hearing
Eating
Sleeping
Walking
Standing
Speaking
Breathing
Learning
Reading
Concentrating
Thinking
Communicating
Working
9
Does you suffer from muscle tension and aches due to anxiety and worry?
All the time
Sometimes
Never
10
Over the past 2 months, how often have you had difficulty sleeping, whether its falling asleep or staying asleep?* This field is required.
Never
Rarely
Sometimes
Often
Always
11
Have you been avoiding situations that make you feel nervous?* This field is required.
All the time
Sometimes
Never
12
Have you been feeling paranoid?* This field is required.
All the time
Sometimes
Never
13
Over the past 2 months, how often have you heard sounds or voices that others don't hear, or seen things that others don't see?* This field is required.
Never
Rarely
Sometimes
Often
Always
14
Calculation
15
You're done! What is your email for us to send your free report as to whether you qualify and would benefit from having an Emotional Support Letter for your pet.* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
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16
Based on your responses to these questions, you do not qualify for an Emotional Support Letter for your pet.

You are still welcome to CLICK HERE and make an appointment to be evaluated by one of our licensed Medical Doctors. Remember, if you are not approved by our doctors, you receive a full refund!
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