ESA Renewal

ESA Renewal

Wise Parts Therapy
In order to receive an ESA renewal letter, I have to see that you are still experiencing symptoms that meet critiera for a disorder and that having your pet helps alleviate those symptoms. Please complete the rest of this form to help me assess if you still meet the criteria.
Name

First NameLast Name
Email
example@example.com
Are you still a Texas resident? (I'm only able to provide this service to Texas residents)
Address of Primary Residence (must be Texas address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender Pronoun
About Your Pet
Type of pet
Name of your pet(s)
If you selected multiple pets, be sure to say which name goes with which type of animal
Breed(s)
Age(s)
Weight(s)
Mental Health Questions
Please select the symptoms that you frequently experience (within the past 6 months) that have caused distress:

Other
Are you currently seeing a therapist? If yes, for how long?
Please describe which symptoms your pet most helps with right now + how they help with those symptoms:
Is there anything else you'd like to share that will help me better assess your continued need for your ESA?
Next Steps
After you submit this form and payment, you'll receive an email with your new letter within 2-4 days if I see that you still meet critieria. If not, I'll reach out to you with more questions first. In the event that you do not meet criteria for the letter, your payment will be refunded.

ESA Renewal Letter

$65

Total

About Your Pet