What is an ESA Letter?
An Emotional Support Animal letter is clinical documentation from a licensed mental health provider confirming that an animal provides therapeutic benefit for a diagnosed psychiatric condition. The Fair Housing Act requires landlords to make reasonable accommodations for ESAs -- including in no-pet housing -- when supported by appropriate documentation from a qualified provider.
ESA letters are distinct from service animal certification. No registration is involved. The requirement is a legitimate clinical letter from a provider licensed in your state who has conducted an appropriate evaluation.
Our ESA Evaluation Process
We do not issue ESA letters without a clinical basis. Every request requires a psychiatric evaluation to confirm a qualifying diagnosis -- anxiety, depression, PTSD, or another condition -- and to establish that an emotional support animal is clinically appropriate as part of the treatment plan.
For existing patients with documented diagnoses, the process is efficient. New patients undergo a standard initial psychiatric evaluation that incorporates the ESA assessment.
What to Expect
Initial evaluations are 45-60 minutes for new patients. We assess psychiatric history, current symptomology, and treatment context. Letters are typically available within a few business days of the appointment for qualifying patients.
Insurance and Payment
The psychiatric evaluation component may be covered by insurance. The ESA letter carries a separate administrative fee not covered by insurance. All fees are disclosed prior to scheduling.
Due Diligence
Letters from online services that bypass clinical evaluation or use providers not licensed in North Carolina carry significant risk of rejection. Landlords and property management companies are increasingly scrutinizing ESA documentation. Our letters are issued by NC-licensed psychiatric providers with full clinical documentation meeting federal and state standards.