NEW Support Pets Facebook (Home2) 1-30-19

1

utm_source

2

utm_medium

3

utm_campaign

4

utm_content

5

utm_term

6

To qualify, what type of pet(s) do you have?* This field is required.

DOG

CAT

BOTH

7

And how many pets do you have?* This field is required.

1 PET

2 PETS

OVER 2

8

Does being with your pet make you feel happy?* This field is required.

Yes, Happy

Not so much

9

Does being with your pet help reduce your stress?* This field is required.

Yes, it does

Not really

10

Do you ever feel sad when you're not with your pet?* This field is required.

Yes, I Get Sad

No, I don't

11

Are you over 18 years old?* This field is required.Must be over 18 for ESA request

YESNO

12

Did any major life events happen in the past 12 months that caused you extra stress?* This field is required.*SUCH AS: divorce, a breakup, financial trouble, unemployment, or death.

YESNO

13

In the last 2 weeks, how often have you had less interest or pleasure in doing things you usually like to do?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

14

In the last two 2 weeks, how often have you felt sad?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

15

In the last 2 weeks, have you felt any angrier, grouchy or more irritated than usual?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

16

In the last 2 weeks, how often have you felt worried, anxious, or on edge?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

17

In the last 2 weeks, how often have you felt afraid or panicked?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

18

In the last 2 weeks, how often have you had irregular sleep?* This field is required.(Sleeping too much or too little)

NEVER

SOMETIMES

OFTEN

ALWAYS

19

In the last 2 weeks, have you been prone to outbursts, mood swings or periods of negativity?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

20

In the last 2 weeks, how often have you been acting impulsively?* This field is required.Shopping too much, sudden use of drugs, alcohol or taking dangerous risks

NEVER

SOMETIMES

OFTEN

ALWAYS

21

Hang in there. You're almost done!

22

In the last 2 weeks, how often have you experienced unexplained aches and pains?* This field is required.Example: head, back, joints, abdomen and/or legs

NEVER

SOMETIMES

OFTEN

ALWAYS

23

In the last 2 weeks have you felt that your illnesses are not being taken seriously?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

24

In the last 2 weeks, how often have you avoided situations that make you nervous?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

25

In the last 2 weeks, how often have you felt paranoid?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

26

In the last 2 weeks, have you had compulsive feelings to perform certain behaviors or mental acts over and over again?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

27

In the last 2 weeks, have you had problems with memory?* This field is required.Example: Remembering new information, finding your way home

NEVER

SOMETIMES

OFTEN

ALWAYS

28

In the last 2 weeks, have you felt detached or distant from yourself or other people?* This field is required.

NEVER

SOMETIMES

OFTEN

ALWAYS

29

I'm sorry, but you do not qualify for an ESA.

30

Describe in detail how your pet(s) help you with reducing stress and anxiety in your life?* This field is required.This is required for ESA approval.

31

Were you aware that pets with ESA approval fly for free, can go inside the terminal and join you at your seat?* This field is required.

No, but that's awesomeYes, I knew that

32

Did you know Pets with ESA approval can live in pet restricted properties and don’t require security deposits or monthly fees?* This field is required.

No, but that's greatYes, I knew that

33

Were you aware that if you're currently paying a monthly pet fee where you live an ESA approval can eliminate that?* This field is required.

No, but that's superYes, I knew that

34

Did you know that many restaurants, stores, hotels, buses, trains and ride share services are more welcoming to ESA approved pets?* This field is required.

No, but that's helpfulYes, I knew that

35

Are you aware US Congress is trying to change the ESA laws that will make it harder and more costly to get approved?* This field is required.Get in before the change.

No, but good to knowYes, I heard that

36

What type is your main pet?* This field is required.

DOG

CAT

37

Provide some details about your main pet* This field is required.Please double check your spelling here.

Pet Name

Pet Breed

Pet Weight in lbs.

38

What type is your second pet?* This field is required.

DOG

CAT

39

Provide some details about your second pet* This field is required.Please double check your spelling here.

Pet Name

Pet Breed

Pet Weight in lbs.

40

Do you want your ESA Approval for Housing, Travel or Both?* This field is required.

HOUSING

TRAVEL

BOTH

41

Are you moving in the next 2 Months?* This field is required.

YESNO

42

Will you be planning any trips in the next 2 Months?* This field is required.

YESNO

43

Are you the pet owner a male or female?* This field is required.Is the human male or female not the pet

MALEFEMALE

44

Enter your full name to be listed on your ESA Documentation?* This field is required.Now, enter your first and last name.

First Name

Last Name

45

What's your phone number?* This field is required.On occasions there might be a follow-up question, or access to special promotions.

Please enter your phone

46

What state do you live in?* This field is required.

47

Lastly, enter your email to see results now!* This field is required.By submitting you are agreeing to the terms of the website and to be contacted by email, phone and/or sms.

example@example.com

48