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Screening
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Registration
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Checkout

Emotional Support Animal Questionnaire

Your answers are confidential and help our professionals determine your eligibility.

Confidential Screening

Your answers are confidential and used to help our licensed professionals and qualification system determine your eligibility. Please answer truthfully.

What type of animal do you have? *

How You’ve Been Feeling Lately

First, let’s check in on how you’ve been feeling over the past two weeks.

In the past two weeks, have you felt down, sad, or hopeless? *
How often have you had little interest or pleasure in doing things you usually enjoy? *
Have you been feeling nervous, anxious, or on edge? *
Have you found it hard to relax or stop worrying? *
Have you been feeling tired, drained, or lacking motivation? *

Behavioral & Emotional Reactions

Now, let’s look at how these feelings might be affecting your behavior.

Have you been withdrawing from friends, family, or social activities? *
Have you noticed mood swings or emotional ups and downs? *
Have you avoided places or activities because they make you anxious or stressed? *

Daily Functioning & Self-Care

These questions help us understand whether your emotional symptoms affect your daily functioning.

Do your emotions or anxiety make it hard to work, study, or focus? *
Do you find it hard to sleep, eat, or care for yourself when feeling low or anxious? *

Your Experience with Animals

These questions help us understand the role an animal might play in your emotional stability.

Would you feel significantly worse if you couldn’t have your animal with you? *
Would your emotional well-being significantly worsen if you could not have your animal with you? *
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