What Is an ESA Letter from a Doctor?
An ESA letter is a signed document from a licensed mental health professional (LMHP) or physician that confirms you have a mental health condition and that an emotional support animal is part of your treatment plan. It’s printed on the provider’s letterhead and includes their license number, your diagnosis category, and a clear statement that you need your ESA for therapeutic benefit.
Unlike service dog certifications, ESA letters don’t require any animal training or registration. The letter itself is the only document that matters legally.
Who can write one? Psychiatrists, psychologists, licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), psychiatric nurse practitioners, and in some states, primary care physicians. The key requirement: they must hold an active license in the state where you live.
Can Your Regular Doctor Write an ESA Letter?
Yes — but it depends on the doctor and the state.
In most U.S. states, any licensed healthcare provider who is qualified to assess mental health conditions can write an ESA letter. Your primary care physician (PCP) absolutely qualifies, and many people prefer this route because they already have an established relationship.
Here’s the catch: some doctors decline. Not because they can’t, but because:
- They’re unfamiliar with ESA letters and worry about liability
- Their practice policy discourages it (some hospital systems have blanket policies against writing ESA letters)
- They don’t feel qualified to assess your mental health — a family doctor focused on physical ailments may prefer you see a therapist
- Time constraints — writing a proper letter takes time they may not have during a 15-minute appointment
If your doctor says no, don’t take it personally. It’s not a judgment on your need — it’s usually about their comfort level with the process.
Step-by-Step: Getting an ESA Letter from Your Doctor
Step 1: Check if You Qualify
ESA letters aren’t available to everyone who loves their pet. You need a qualifying mental health condition recognized in the DSM-5-TR, such as:
- Generalized anxiety disorder
- Major depressive disorder
- Post-traumatic stress disorder (PTSD)
- Social anxiety disorder
- Panic disorder
- Bipolar disorder
- Obsessive-compulsive disorder (OCD)
- Phobias that limit daily functioning
The condition must meaningfully affect at least one major life activity — work, sleep, concentration, social interaction, or daily routines. If you’re already being treated for any of these, you’re likely a strong candidate.
Step 2: Schedule the Right Kind of Appointment
Don’t try to squeeze this into a routine checkup. Book a dedicated appointment and let the scheduling staff know you want to discuss mental health support, including the possibility of an ESA letter. This ensures:
- Enough time is allocated (at least 20-30 minutes)
- Your doctor can review your mental health history beforehand
- The conversation isn’t rushed
Step 3: Prepare for the Conversation
Bring documentation. The more prepared you are, the smoother this goes:
- Your mental health history — previous diagnoses, medications, therapy records
- Specific examples of how your condition affects daily life
- Evidence of how your animal helps — reduced anxiety episodes, better sleep, ability to leave the house
- An ESA letter template (we have a complete template guide you can bring)
Be honest and specific. “My dog helps with my anxiety” is vague. “Since getting my dog, my panic attacks dropped from 3-4 per week to about one, and I’m able to go grocery shopping again” — that gives your doctor something concrete to document.
Step 4: Have a Direct Conversation
When you’re in the appointment, be straightforward:
“I’ve been managing [condition] for [time period], and my animal has made a real difference in my symptoms. I’d like to discuss getting an emotional support animal letter so I can keep my pet in my apartment / have housing protection.”
Most doctors appreciate directness. Avoid being vague or hinting — they’re busy, and clarity helps.
If your doctor has questions about what an ESA letter requires, point them to the HUD guidelines on assistance animals, which outline the federal framework.
Step 5: Ensure the Letter Includes Everything
A valid ESA letter must contain these elements. If your doctor’s letter is missing any of them, landlords can (and do) reject it:
- Written on official letterhead with the practice’s contact information
- Doctor’s full name, license type, and license number
- State where the license is active
- Date of issuance
- Statement that you are their patient
- Confirmation of a DSM-5 qualifying condition (the specific diagnosis does NOT need to be disclosed)
- Statement that the ESA is necessary for your mental health treatment
- Doctor’s signature (wet or electronic)
Pro tip: the letter should not name your specific diagnosis. It only needs to confirm you have a qualifying condition. Your privacy matters, and federal housing law doesn’t require diagnostic disclosure.
What If Your Doctor Says No?
You have three solid alternatives:
Option 1: See a Therapist or Psychiatrist
Mental health specialists write ESA letters regularly and are generally more comfortable with the process. If you’re not currently seeing a therapist, this is a good reason to start — the evaluation itself can be valuable regardless of the letter.
Option 2: Use a Legitimate Telehealth Service
Several telehealth platforms connect you with licensed mental health professionals who evaluate you for ESA eligibility. The good ones conduct real assessments (30-45 minutes), not 5-minute rubber stamps.
What to look for in a legitimate service:
- Licensed provider in YOUR state conducts the evaluation
- Real-time video or phone assessment (not just a questionnaire)
- Money-back guarantee if you don’t qualify
- Letter comes on the provider’s professional letterhead
- They don’t guarantee approval before the evaluation
Red flags to avoid: instant approval, no evaluation, “register your ESA” language, letters for $20 or less (legitimate evaluations cost $100-$250 because a real professional’s time is involved). For more on pricing, check our guide to ESA letter costs.
Option 3: Ask for a Referral
Even if your PCP won’t write the letter, they can refer you to a colleague who will. Ask: “Can you refer me to a mental health professional who handles ESA evaluations?”
How Much Does a Doctor’s ESA Letter Cost?
The cost varies depending on your path:
- Through your existing doctor: Usually just the copay for a regular appointment ($20-$75 with insurance). Some doctors charge a separate documentation fee ($50-$150).
- Through a therapist or psychiatrist: $100-$250 for an initial evaluation, which may be partially covered by insurance if billed as a mental health assessment.
- Through telehealth platforms: $100-$250, rarely covered by insurance.
Your existing doctor is almost always the cheapest option — another reason to try that route first.
ESA Letters: What’s Changed in 2026
The ESA letter landscape has shifted significantly in recent years. Here’s what’s current:
Housing (Fair Housing Act): ESA letters still provide strong protection. Under the Fair Housing Act, landlords must make reasonable accommodations for tenants with ESAs, including waiving no-pet policies and pet deposits. HUD issued updated guidance in 2020 (FHEO-2020-01) that remains the standard, which tightened rules around who can write ESA letters but didn’t eliminate protections.
Air travel: The Department of Transportation’s 2021 rule change means airlines are no longer required to accommodate ESAs in the cabin. Most major U.S. airlines now treat ESAs as regular pets. A few international carriers still honor ESA letters, but don’t count on it for domestic flights.
State laws: Several states have passed laws cracking down on fraudulent ESA letters while protecting legitimate ones. These laws typically require:
- An established patient-provider relationship (not a one-off online questionnaire)
- The provider to be licensed in the state where you reside
- A genuine clinical evaluation, not a rubber stamp
This is actually good news for people with legitimate needs — it makes fake letters easier to challenge and real ones harder to dismiss.
Common Mistakes to Avoid
Don’t buy an ESA “registration” or “certification.” There is no official ESA registry. Sites selling certificates, ID cards, or vest-and-badge kits are taking your money for items with zero legal standing. The only document that matters is the letter from your licensed provider. Read more in our ESA certification guide.
Don’t use an out-of-state provider. HUD’s 2020 guidance specifically addresses this. Your evaluating provider should be licensed in the state where you live. An out-of-state letter gives landlords a legitimate reason to request additional verification.
Don’t let your letter expire without renewing. Most ESA letters are valid for one year. Set a reminder to get a new one before it lapses — especially if you’re renting. Some landlords check annually.
Don’t confuse ESAs with service animals. Service dogs are trained for specific disability-related tasks and have broader public access rights under the ADA. ESAs provide comfort through companionship but don’t have the same access to restaurants, stores, or workplaces. Knowing the distinction protects you from misrepresenting your animal’s status, which can carry legal penalties in many states.
Frequently Asked Questions
Can a nurse practitioner write an ESA letter?
Yes. Psychiatric nurse practitioners (PMHNPs) and, in many states, regular nurse practitioners (NPs) can write ESA letters as long as they’re licensed to assess and treat mental health conditions.
Do I need to see the doctor in person?
Not necessarily. Since the pandemic, telehealth evaluations have become widely accepted for ESA letters. However, some states require at least one in-person or video visit (not phone-only) to establish a patient-provider relationship. Check your state’s telehealth regulations.
How long is an ESA letter valid?
Most ESA letters are written with a one-year validity period. There’s no federal law mandating a specific expiration, but landlords and housing authorities commonly expect letters issued within the past 12 months.
Can my landlord reject my ESA letter?
A landlord can request additional verification if the letter appears fraudulent, comes from an out-of-state provider with no patient relationship, or lacks required elements. They cannot reject a properly written letter from your treating provider simply because they don’t want pets in the building. If they do, that’s a potential Fair Housing Act violation — you can file a complaint with HUD.
Can I get an ESA letter for more than one animal?
Yes, but each animal needs clinical justification. Your provider must explain why multiple ESAs are necessary for your treatment. Getting a letter for one animal is straightforward; getting one for three cats and two dogs is a harder sell, and landlords are more likely to push back.
