ESA Evaluation Query Form

1

Start Your Legitimate ESA Evaluation Request

Take a short 2 minute background questionnaire
Schedule a clinical consultation with a licensed Texas-based therapist
Receive your letter within 24-hours, if approved.

Talk with the therapist today! Get ESA documentation if you have a qualifying mental health condition (determined through a thorough clinical review and assessment).

Our letters are Fair Housing Act (FHA) compliant.

2

Are you physically located in the State of Texas?* This field is required.

YESNO

3

Name* This field is required.

First Name

Last Name

4

Are you 18 or older?* This field is required.Note: if under 18, a parent will need to sign an online consent form prior to the evaluation

YESNO

5

Birthdate* This field is required.

Date

6

E-mail* This field is required.

example@example.com

7

Phone Number* This field is required.

8

What type of accommodation are you requesting documentation for?* This field is required.Select all that apply

Apartment Housing

Rental Home

College Domitory

Other

9

For Other Accommodation type, please provide details* This field is required.

10

ESA Detail Information* This field is required.Enter details for each ESA; select how each helps you (Helps Me By should be different for each one). Note that the therapist will be conducting a thorough evaluation to determine whether you truly qualify for each ESA.

11

Are you available now for a clinical consultation to see if you qualify? Note: we can talk to you between 8am-10pm.* This field is required.

YESNO

12

Can you give us a date and time you are available for a phone call?* This field is required.

13

Have you ever been diagnosed with Anxiety?* This field is required.

YESNO

14

Have you ever been diagnosed with Depression?* This field is required.

YESNO