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How Long After an ESA Medical Assessment Do I Get a Letter?

More people are discovering the mental and emotional health benefits of emotional support animals. The treatment has been on an upwards trend in recent years, and mental health service providers are responding by making the process available online, allowing more people to access this option.


However, to qualify for an ESA letter, you must first undergo an assessment and evaluation from a mental health professional wh is licensed in your state. He or she will determine whether an emotional support animal should be part of a broader treatment plan based on your condition, your symptoms, and other factors.


Once you undergo your assessment, how soon can you expect to receive your ESA letter?


At Therapy Pets, you will receive your ESA letter within 72 hours of your provider issuing it. Letters are mailed directly to your door, and you can start using it immediately.


Here’s what you need to know about the medical assessment process so you can set the right expectations.

Do I Need a Medical Assessment to Get an ESA Letter?

If someone told you they got their ESA letter online, it’s entirely plausible. Many individuals who experience a mental or emotional health conditions are turning to online channels because of the convenience and speed it offers. It eliminates any transportation barriers that may prevent you from seeking treatment in person. It also reduces the time it takes to find and connect with a licensed health professional in your area who is qualified to treat a condition like yours. Plus, you don’t have to way for an appointment to become available, which could take several days, weeks, or even months before you are seen by a doctor or therapist.


However, choosing an online ESA letter doesn’t mean you are exempt from speaking with a professional. The main difference is that you can talk with someone remotely and skip the typical office visit. Your licensed mental health provider will likely conduct an evaluation or assessment to learn more about your symptoms. Being candid about your symptoms and condition and how it impacts your everyday life can help your provider make the most helpful and accurate decision on whether to prescribe an emotional support animal for you.


You will not have to undergo a physical, bloodwork, or other tests to qualify for an ESA letter. However, your provider may want (or be obligated by law) to speak with you over the course of several sessions before making a determination. Some assessments simply can’t be completed in a single therapy session. Providers that take their time in learning more about your condition want to be able to help you to the fullest, so know that getting an ESA letter is usually a marathon, not a sprint.

What’s in an ESA Assessment?

A recent study mentioned that a thorough assessment when determining the need for an emotional support animal should consist of four parts:


  • The provider’s recognition and application of laws pertaining to emotional support animals;
  • A thorough disability assessment of the individual, including diagnosing the condition and understanding the person’s symptoms;
  • An assessment of the animal which will provide emotional support; and
  • An assessment of the client/animal interactions and how symptoms of the condition are alleviated.


However, these are just recommendations from a single study. Mental health providers, primary care physicians, and other authorized licensed providers may each take a different approach in determining the need for an emotional support animal.


For example, some patients choose to start with their primary care physician if they have previously received care for their mental condition. Their physician is in a good position to make a proper determination if they have written prescription medications for the patient for this condition or otherwise have been treating them over time. They also have a full understanding of the person’s medical history, which may help in making a sound determination.


Counselors, therapists, and other licensed professionals that specialize in mental health may take an entirely different approach. They might want to schedule multiple sessions to provide you with a diagnosis if you do not already have one, for example. In order to qualify for an ESA, you must:


  • Have a qualifying mental or emotional disability that is recognized in the Diagnostic and Statistical Manual; and
  • Have symptoms that are improved with the presence of an emotional support animal.


Ensuring an individual meets these two criteria may require different processes. Your licensed healthcare provider can offer more insight into the process based on your condition and unique circumstances.

Who Can Conduct an ESA Medical Assessment?

There are many types of healthcare professionals you can speak with to get an ESA assessment. The type of professional you choose, however, may affect the process of how you receive your emotional support letter.


The following professionals are legally authorized to write an ESA letter for you:


  • Primary care physicians
  • Physician’s assistants
  • Nurse practitioners
  • Psychiatric mental health nurse practitioners
  • Psychiatrists
  • Psychologists
  • Licensed clinical social workers
  • Licensed professional counselors
  • Licensed marriage and family counselors


Some of these professionals specialize in mental and emotional health conditions. They work directly with patients who have specific mental illnesses, such as PTSD, schizophrenia, bipolar disorder, or severe anxiety or depression. Depending on your symptoms and diagnosis (if you have one), you should take care to choose the right health professional who can speak with you regarding your illness.

Primary Care Physician

Your primary care doctor can write an ESA letter if they have also been providing treatment for your mental or emotional health. Many individuals start their journey here because they have a pre-existing relationship with their PCP. What’s more, they can lean on this established relationship and trust to get an appointment quickly without having to be placed on a waiting list or wait weeks for an opening.

Physician’s Assistant

If you typically see a physician’s assistant (PA) for a mental or emotional condition or your general well-being, a PA may also be able to write an ESA letter. PAs work directly under a physician and are authorized to write medical prescriptions and recommend treatments.

Nurse Practitioner

Similar to PAs, a nurse practitioner works directly under the supervision of a doctor and can write prescriptions. Many patients see a nurse practitioner for their regular wellness care as well as general health conditions.

Psychiatric Mental Health Nurse Practitioner

Psychiatrist mental health nurse practitioners work with psychiatric patients of all ages in a variety of settings. They provide medication and therapy for patients with substance abuse or mental health disorders, conduct assessments, and recommend treatment options, such as authorizing an emotional support animal.



Psychiatrists specialize in mental health conditions and routinely work with patients to uncover connections between emotions, physiological behaviors, past traumas, family life, and other events. They typically take a deep-dive approach to understand each patient’s dynamics and recommend appropriate treatments. Patients often choose psychiatric help when they experience long-term anxiety and depression, are considering suicide, have panic attacks or hallucinations, or feel that everyday life is distorted or no longer within their control.


A psychologist works with individuals on psychological and behavioral conditions. Examples include (but are not limited to) eating disorders, addiction, stress and anxiety, autism, sleep disorders, and ADHD. They support their patients by working toward a diagnosis and providing potential treatment options, such as the use of an emotional support animal. Patients usually choose a psychologist when they have jumbled thoughts that need clarity or need to cope with a specific event or habit in their life.

Licensed Clinical Social Worker

Licensed clinical social workers specialize in social work and have received their Master’s degrees and a professional license. Their primary role is to provide treatment to individuals with mental health conditions that are severe enough to impact daily living.


And because of their professional licensure, they are also able to diagnose and treat issues (in some states), even though they are not licensed to prescribe medications. One example of this is the ability to write an ESA letter for a patient if the LCSW believes it will benefit their condition.

Licensed Professional Counselor

Licensed professional counselors are trained in mental, emotional, and behavioral health issues. Their primary goal is to work with individuals or groups in helping them find better alternatives to handle daily life. For example, if a person suffers from severe PTSD the point where they can’t hold a steady job or go to the grocery store without risking a panic attack, a licensed counselor can suggest other ways to cope. They spend much of their time talking with their patients in order to make the appropriate suggestions.

Licensed Marriage and Family Counselor

A licensed marriage and family counselor (LMFC) works primarily with family units, such as married couples or entire households. They are often the first resource when couples are considering or going through a divorce. They may work with parents in coping with an unruly teenager. They might be sought if the family has suffered the loss of a member of the household. The LMFC’s goal is to create feelings of harmony, understanding, and love in the home. They might recommend an emotional support animal to help foster these feelings, elevate moods, and improve relationships between family members.

Why Do I Need a Medical Assessment for an ESA Letter?

Animals offer a number of health benefits, from reducing stress to making their owners feel happier. But the difference between a pet and an emotional support animal is who it’s intended for and why.


A person who qualifies for an emotional support animal is typically considered to be someone with a disability. However, a doctor or licensed mental health provider must make this determination. With a diagnosis or a doctor’s recommendation, persons holding an ESA letter can expect to enjoy the legal rights and protections that comes with having a bona fide emotional support animal.


The other reason that a medical assessment is required is that an ESA letter should not be your end game. Rather, it’s a part of an overarching treatment plan to help you live better and more independently.


The real goal is to help you improve your symptoms and enjoy a higher quality of life. This goal becomes more feasible when you choose the right type of professional that has experience in conditions like yours and can recommend additional treatment options for you.


To learn more about who is eligible to write an ESA letter, check out our complete blog post: Who is Eligible to Write an ESA Letter.

What California Residents Should Know about Obtaining ESA Letters

Ultimately, it’s up to your mental healthcare professional to decide when and if to issue an ESA letter in your name. However, for residents in California, the timeline looks a little different.


New regulations (as of September 2021) now require health providers to have an established relationship with a patient for at least 30 days prior to writing an ESA letter.


One possible reason for this timeframe extension is the rise of fake emotional support animals and letters. California’s Department of Urban Housing and Development has received an influx of calls and complaints related to discrimination regarding emotional support animals and a general misunderstanding of what ESAs are, who they’re intended to help, and their legal rights.


In an effort to curb the growth of fake ESA letters, an extended timeframe is helping to weed out potential scammers who won’t take the extra steps required to receive a letter. This helps to preserve the integrity of the process for disabled individuals who truly need and benefit from an emotional support animal and separates them from those who just want to avoid pet housing and travel fees.


To learn more about the process of getting an ESA letter in California, read our latest blog post: How to Get an ESA Letter in California.

How Much Does an ESA Letter Cost?

Many individuals mistakenly believe they can pay a fee for an ESA letter, and that’s that. While there are plenty of scam websites that would have you believe this, it’s not exactly true.


Yes, you will pay a fee for an ESA letter. But you’re not just paying for the letter. Rather, you are also paying for a consultation with a licensed mental health provider, much like you would pay for both a visit with your doctor and the medication they prescribe. An ESA letter is essentially a prescription with your name on it, after all.


So, when you think about how much an ESA letter costs, you want to consider the entire process of receiving the letter, not just the letter itself. Costs can vary by state, especially since it might require several visits or sessions with a healthcare professional before you receive the green light for your ESA letter.


If you are looking for a baseline cost, though, valid ESA letters typically start around $150 and increase from there. This usually includes one online meeting with a licensed counselor or therapist and the cost of mailing the letter to your door. However, if more sessions are needed by the counselor or required by law, like in the state of California, then the cost of obtaining an ESA letter will likely be more.


Be cautious of websites that offer low flat rates and guarantees for ESA letters. Anyone can put words on paper and sell it for $100 and make a nice profit. But if the letter isn’t valid, then no low price will ever be better than paying more money for the real thing. You truly do get what you pay for.


To save yourself time, money, and hassle, you can take our free assessment online to see if you might qualify. The assessment will ask you a few simple questions, and your answers will be used to connect you with the right mental health professional in your state. If you do not pass the assessment, you can explore other potential treatment options or see if you can enjoy the calming benefits of an emotional support letter without the actual letter.


And if you do pre-qualify, you will be one step closer to completing the process and receiving your ESA letter.


Keep in mind that pre-qualifying to speak with a counselor is not a guarantee that you will be eligible for an ESA letter. Only a healthcare professional can make this decision.

Can I Receive My ESA Letter Instantly?

If your licensed mental health professional agrees that you should qualify for an emotional support animal, he or she will write a custom letter in your name, sign it, and print it on their official letterhead. For these reasons, an instant digital download of your ESA letter is not an option.


Even though we are living in the era of e-signatures and the technology to enable digital downloads is possible, an ESA letter is an official document. We want to ensure there is no reason why your ESA letter’s validity would ever be questioned or rejected, so we take presentation seriously.

How Does Therapy Pet Send My ESA Letter?

Once your provider issues the letter, you will receive your copy in the mail within 72 hours with expedited shipping options. We know you’re eager to start reaping the benefits an emotional support animal can bring. That’s why we’re dedicated to putting your letter in your hands as soon as possible while adhering to regulations and requirements.

Get Started with Therapy Pet!

If you have considered the benefits of an emotional support animal and want to explore it as a potential treatment option, you first need to connect with a licensed mental healthcare provider or your primary care physician. The only way to receive a valid ESA letter is to undergo a medical evaluation or assessment to see if you qualify.


At Therapy Pets, we’re here to help you take the next step remotely. Our service can help you see if you might qualify for an ESA letter, as well as connect you with a licensed professional in your state. Start here with our free 5-minute assessment.

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