Online Pre-Screening

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Pre-Screening Questionnaire

The questionnaire will help to see if your can qualify for the benefits of an ESA Doctor's Letter.

Licensed in your state. Our licensed therapists are extensively vetted and in good standing
Match to your needs. We ensure they have the right experience to handle your ESA needs
Meet any timeline. Our deep network of therapists means we can meet any timeline

First, let us start by asking you a few questions about you and your pet....

What is your first name? *

Do you have a pet?

Do you have a pet? *

What type of pet do you have?

What type of pet do you have? *

Dog
Cat
Other

What is your pet's name?

What is your pet's name? *

Next, let me find out how you have been feeling lately....

In the past (2) weeks, have you been under high levels of Stress? *

Never
Rarely
Sometimes
Often
Always

In the past (2) weeks, have you felt depressed and or sad?

In the past (2) weeks, have you felt depressed and or sad? *

Never
Rarely
Sometimes
Often
Always

In the past (2) weeks, how often have you felt more tense and up tight than usual?

In the past (2) weeks, how often have you felt more tense and up tight than usual? *

Never
Rarely
Sometimes
Often
Always

Over the past (2) weeks, have you experienced anxiety, felt worried or anxious?

Over the past (2) weeks, have you experienced anxiety, felt worried or anxious? *

Never
Rarely
Sometimes
Often
Always

In the past (2) weeks, how often have you felt panicked or afraid?

In the past (2) weeks, how often have you felt panicked or afraid? *

Never
Rarely
Sometimes
Often
Always

Next, lets talk about any behavioral changes you might be experiencing...

Over the past (2) weeks, how often has your stress level interfered with your sleep? (Sleeping too little or too much) *

Never
Rarely
Sometimes
Often
Always

In the past (2) weeks, have you been acting impulsively? (Sudden use of drugs or alcohol, spending money erratically, feeling invincible)

In the past (2) weeks, have you been acting impulsively? (Sudden use of drugs or alcohol, spending money erratically, feeling invincible) *

Never
Rarely
Sometimes
Often
Always

In the past (2) weeks, have you been prone to outbursts, mood swings or periods of negativity?

In the past (2) weeks, have you been prone to outbursts, mood swings or periods of negativity? *

Never
Rarely
Sometimes
Often
Always

We're done! We have completed the online questionnaire.

Please enter your email & phone number below to get your results :

Email *

Phone *