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Date:
To Whom It May Concern:
Patient is under my care and I am currently treating her for a mental health disability recognized in the DSM IV-TR. I have diagnosed her with Disorder and DSM IV Code Her disorder substantially limits at least one major life activity.
As the primary treatment to address her psych- ological disability, I have prescribed Patient to obtain a dog or a cat to serve as an emotional support animal. It is my professional opinion that the presence of this animal is a necessary
treatment for the mental health of Patient because its presence will mitigate the symptoms she is currently experiencing.
Patient meets the definition of disability under the Americans with Disabilities Act, the Fair Housing Act, and the Rehabilitation Act of 1973. Due to mental illness, Patient has certain limitations regarding [social interaction/coping with
stress/anxiety, etc.]. In order to help alleviate these difficulties, and to enhance her ability to live independently and to fully use and enjoy the dwelling unit you own and/or administer, I am
prescribing an emotional support animal that will assist Patient in coping with her disability.
LPC License #
Date LPC License Issued:
Sample Letter to Request Reasonable Accommodation
Emotional Support Pet Housing Letter (Sample)
[DATE]
[NAME OF BUILDING MANAGER]
[ADDRESS]
Re: Reasonable Accommodation for my disability
Dear [BUILDING MANAGER NAME]:
I live at [ADDRESS] in [UNIT NUMBER] and have lived there since [DATE]. I am a qualified individual with a disability, as defined by the Fair Housing Amendments Act of 1988.
Our building's rules state [XXX]. Because of my disability my mental health specialist has prescribed an emotional support animal (dog/cat) to ensure my emotional well being and I need the following accommodations: [LISTACCOM- MODATIONS - modification of No-Pet Policy]. I would like to meet with you to discuss these and any other accommodations that will enable me to have an equal opportunity to live in and enjoy this residence.
I have attached verification of my disability and my prescription for an emotional support animal. Under the Fair Housing Amendments Act, it is unlawful
discrimination to deny a person with a disability a reasonable accommodation of an existing building rule or policy if such accommodation may be necessary to afford such person full enjoyment of the premises.
Please keep this request for accommodation confidential, as required by federal law. Please contact me within the next ten days to discuss this important issue. I look forward to your response and appreciate your attention to this matter.
Sincerely,
Signature
Resident Name
Emotional Support Pet Airline Letter (Sample)
Emotional Support Animal letters are based upon federal law (both airline and housing) and must comply with either the Air Carrier's Access Act or the Fair Housing Act
Airline Prescription Letters must state:
(1) The passenger has a mental or emotional disability recognized in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV);
(2) The passenger needs the emotional support or psychiatric service animal as an accommodation for air travel and/or for activity at the passenger’s destination;
(3) The individual providing the assessment is a licensed mental health professional, and the passenger is under his or her professional care; and
(4) The date and type of the mental health profess- ional’s license and the state or other jurisdiction in which it was issued.
Date:
To Whom It May Concern:
Patient is under my care and I am currently treating him for a psychological disability recognized by the DSM IV-TR. I have diagnosed him with Disorder and DSM IV Code. His disability substantially limits at least one major life activity.
It is my professional opinion the presence a emotional support animal is necessary to treat and alleviate Patient’s disorder. I have prescribed Patient to obtain a dog or a cat to serve as an emotional support animal as the primary treatment to address
his disability.
Please allow Patient to be accompanied by his emotional support animal in the cabin of the aircraft, in accordance with the Air Carrier Access Act (49 U.S.C. 41705 and 14 C.F.R. 382).
LPC License #
Date LPC License Issued: