You can open the ESA Letter Template For Doctor in multiple formats, including PDF, Word, and Google Docs.
ESA Letter Template For Doctor Printable | Editable FormSample
Examples
[Patient’s Full Name]
[Patient’s Date of Birth]
[Patient’s Address]
[Patient’s Email]
[Patient’s Phone]
[Doctor’s Full Name]
[Doctor’s License Number]
[Doctor’s Specialty]
[Doctor’s Practice Name]
[Doctor’s Address]
[Date of the Letter]
Emotional Support Animal (ESA) Recommendation for [Patient’s Full Name]
I, Dr. [Doctor’s Full Name], am a licensed [Doctor’s Specialty] and have been treating [Patient’s Full Name] since [Start Date of Treatment]. This letter is to confirm that [Patient’s Name] has a mental or emotional disability recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Based on my professional evaluation, I recommend that [he/she/they] have an emotional support animal (ESA) to assist with [his/her/their] treatment.
[Provide a detailed description of the patient’s condition, including relevant symptoms and how the ESA will assist in treatment. Include length and nature of treatment and any prior progress or changes in the patient’s condition.]
The presence of an emotional support animal will provide [Patient’s Name] the necessary comfort to alleviate the symptoms of [Specific Symptoms]. An ESA plays a critical role in [his/her/their] therapeutic process, promoting mental well-being and enhancing [his/her/their] quality of life.
It is my professional opinion that an emotional support animal would be highly beneficial for [Patient’s Name]. I highly recommend that [he/she/they] be permitted to have an ESA [if applicable, mention any specific situations such as housing or travel regulations].
Sincerely,
[Signature of the Doctor]
Dr. [Doctor’s Full Name]
[Doctor’s License Number]
[Doctor’s Practice Name]
[Patient’s Full Name]
[Patient’s Date of Birth]
[Patient’s Address]
[Patient’s Email]
[Patient’s Phone]
[Doctor’s Full Name]
[Doctor’s License Number]
[Doctor’s Specialty]
[Doctor’s Practice Name]
[Doctor’s Address]
[Date of the Letter]
Emotional Support Animal (ESA) Recommendation for [Patient’s Full Name]
As a licensed [Doctor’s Specialty], I, Dr. [Doctor’s Full Name], have been treating [Patient’s Full Name] since [Start Date of Treatment]. Following my assessment, I am writing to officially recommend [him/her/them] for an emotional support animal (ESA) to help enhance the treatment of [his/her/their] diagnosed mental health condition.
[Briefly describe the patient’s diagnosis, treatment progress, and any specific therapies being utilized. Include the impact of the emotional support animal on the patient’s overall treatment plan.]
The emotional support animal provides [Patient’s Name] with companionship and support, which are vital to managing [his/her/their] symptoms of [Specific Symptoms]. [Explain how the ESA has positively impacted the patient’s mental health and daily life.]
In my opinion, the presence of an emotional support animal in [Patient’s Name]’s life is not just beneficial but essential for [his/her/their] ongoing therapy. I strongly encourage that [he/she/they] retains the rights to have [his/her/their] ESA in relevant settings, as it serves to support [his/her/their] recovery and emotional stability.
Respectfully,
[Signature of the Doctor]
Dr. [Doctor’s Full Name]
[Doctor’s License Number]
[Doctor’s Practice Name]
Format
Please complete the form below to create the Emotional Support Animal (ESA) Letter Template for Doctor. All fields must be filled out to ensure a valid and comprehensive letter. We provide examples to guide you through each step. Emotional Support Animal Letter Template for Doctor 1. Patient Information 2. Physician Information 3. ESA Details 4. Medical Justification 5. Treatment Duration 6. ESA Letter Validity 7. Terms and Conditions 8. Signatures and Acceptance 9. Declaration and Signatures
PDF
WORD
Google Docs
ESA Letter Template For Doctor Printable | Editable FormPrintable
