All About Emotional Support Animal Letters and ESAs

1. Is it legal to diagnose and treat a patient over the internet?

Yes – our services are completely legal and ethically acceptable in the USA. It is becoming increasingly common for therapists to perform therapy and crisis intervention over the telephone, and medical doctors even prescribe medications over the phone and the internet.

2. I noticed that Chilhowee Psychological Services (CPS) is located in Colorado, but I live in a different state. Will the airlines reject the CPS letter if they see that I'm not from Colorado?

Because there are no legal or professional ethical guidelines that prohibit or limit the ways in which or where assessments are performed, diagnoses made, or treatment is prescribed, written or digitally transmitted, the airlines may not reject a treatment recommendation letter on that basis. By law. Period.

3. How is Chilhowee Psychological Services (CPS) able to accurately assess and diagnose a client?

The assessment process begins when a client completes a 11 component online test battery, which includes clinical session questions to collect background information, tests to assess current functioning, and a thorough medical and mental health history. The test battery uses 256-bit encryption to keep a client’s responses private.

Once this comprehensive test battery has been scored, a contracted, licensed mental health professional (LMHP) reviews the results of each test, paying particular attention to the client’s subjective responses and medical/mental health history.

Using the test results and other ancillary information (e.g., information from other health care providers, etc.) as a foundation, the licensed mental health professional will contact the client to establish a series of telephone and/or Skype counseling sessions to further evaluate his/her mental and emotional status. These counseling sessions are required to formulate an informed disability determination and cannot be bypassed.

4. Is it possible for me to review the test battery before paying for your services?

No. It isn’t possible for prospective clients to preview the questions and components of our psychometric/psychosocial test battery prior to ordering and paying for the CPS disability assessment.

5. How long does it take to receive my assessment and treatment recommendation letter?

The majority of clients are able to complete the online clinical testing and session component of the process in approximately two hours. Once the test battery is complete, it is usually scored and analyzed within 24 – 48 hours. The assigned therapist will typically email or call the client within 2 – 3 days of ordering to establish dates and times for the telephone/Skype counseling sessions. The actual assessment and diagnostic process begins when our clinicians score the completed test battery.

The availability of the client and the number of counseling sessions necessary for the licensed mental health professional to make a valid assessment (a minimum of two) will determine how long the process takes. The process can take as little as several days and as long as two weeks. If a client qualifies as emotionally or mentally disabled, a formal treatment recommendation letter for an emotional support animal will be written, signed by the licensed mental health professional and mailed via USPS Priority Mail. Clients typically receive their documentation within 3 – 4 days, once mailed.

This usually transpires within 24 hours of the formal assessment. Then, within 24 – 48 hours, our licensed therapist writes and signs the treatment recommendation letter, which is then sent via USPS Priority Mail. As soon as your documents are shipped, we’ll send you an email confirmation with tracking information. Priority Mail packages usually arrive within 1-3 days of being shipped. The total elapsed time from when a client completes the test battery and when the documents are received is typically a week. If you also ordered printable PDF copies of your documents, they will be emailed the afternoon your printed documents are shipped, meaning you’ll usually have them just 2-4 days after ordering.

6. Are Chilhowee Psychological Services (CPS) clinical staff licensed mental health professionals?

Yes. The therapists who assess you and make a disability determination are third-party, licensed mental health professionals (LMHP).

7. I have two (2) dogs that I want to become ESAs for me. Will airlines allow more than one dog and does your treatment recommendation letter address multiple dogs?

Although we can’t guarantee that all airlines will allow two or more ESAs per handler without exception, it is common practice for them to allow two small animals to fly in the cabin of the aircraft with their disabled handler. It’s a good idea to consult with the airline you’ll be using to let them know you’ll be travelling with two ESAs and want to make sure there will be no problems. When you order our assessment services and treatment recommendation letter, you can specify the option of “one or more ESAs” so your letter will reflect that you may have more than one.

8. If the airlines or property manager calls Chilhowee Psychological Services (CPS) to verify the letter and confirm that the CPS therapist is appropriately licensed, do you answer those calls?

Yes. A fee for this service applies. Before we can even legally confirm that you’re our client, however, you must order an Information Release Service, complete it, and send back to us (this form should be ordered at the time you order your assessment and treatment recommendation letter). Many airlines require passengers to fax or email their treatment recommendation letter in advance of their flight so that airline personnel can, if they deem it necessary, 1) accept the letter, 2) reject the letter, or 3) call the mental health professional to verify the letter and/or confirm the licensing information of the therapist.

If airlines personnel or property management call our office for verification and we’re unavailable (after hours or clinicians are with clients, etc.), staff will return the call as quickly as possible. We understand that your hassle-free flight or tenancy approval depends on this communication.

9. My property manager/landlord/college has a form that must be completed by my doctor or therapist for me to have an emotional support animal (ESA). Is this a service you offer?

Yes. A fee for the Verification Form Completion Service applies and is outside of the assessment and prescriptive letter we provide. In addition to the Verification Form Completion Service, an Information Release Form must be ordered and returned to us, legally authorizing us to release your information. Many property management companies, landlords, as well as colleges and universities require completion of an official ESA housing form by your therapist or physician prior to approving an emotional support animal for a resident. Although forms differ, they typically ask for detailed information about the client, emotional/psychological status, diagnosis, when treatment began, diagnostic prognosis, and other personal, subjective information. We can’t guarantee that the responses we provide on this form will assure approval from your landlord, property manager, or college/university.

10. If I pay for a treatment recommendation letter for an ESA, am I guaranteed to qualify for it?

Ordering services doesn’t guarantee a client will qualify as disabled.

There really isn’t anything typical when it comes to the emotional/psychological status of a person; every person’s situation, ability to cope, and life experience is different. In addition, to qualify, it isn’t enough to simply be diagnosed, but a person must be determined to be incapacitated by the negative effects of their disorder.

11. Does Chilhowee Psychological Services (CPS) report the findings of my assessment to any other agencies or entities?

No. We never report any client information to outside agencies or entities unless the client has paid for and submitted an Information Release Form for a specific entity.

12. What's the difference between an Emotional Support Animal (ESA) and a Psychiatric Service Animal (PSA)? Which one should I choose?

Emotional Support Animal (ESA)
An emotional support animal (ESA) is a dog that belongs to a person who is emotionally or psychologically (psychiatrically) disabled. The person’s mental health practitioner (a licensed mental health professional) has determined that the presence of the animal is necessary for the disabled person’s mental health and has written a prescription stating the dog is necessary for the normal day to functioning of the disabled person. The dog needs no special training. Under current ADA and Fair Housing laws, an ESA is ONLY protected as follows:

To qualify for “no” or “limited” pet housing.
To fly in the cabin of an aircraft with the disabled handler.
Psychiatric Service Animal (PSA)
Psychiatric Service Dogs are regarded as service animals. They are individually trained in obedience, performing tasks, and working in distracting public environments to mitigate their partner’s psychiatric disability. Their primary function is not to provide emotional support, but to perform tasks which enable their partner to function in ordinary ways a non-disabled person takes for granted. The handler of a PSA must be able to present a treatment recommendation letter for a PSA from a medical doctor or licensed mental health professional.

It is not enough to have a mental illness to qualify as a person with a disability under the ADA. According to the National Institute of Mental Health (NIMH), 26.2% of adults in the U.S. suffer from a mental illness in any given year, but only 6% are severely mentally ill. So more than three quarters of those with a diagnosed mental illness are not disabled by that illness to effectively qualify to use a service animal, even if they would benefit from one.

A qualified task is a trained behavior that mitigates a person’s disability by doing something the partner cannot do for themselves, but must be able to do in order to live. Even if you could benefit from a trained behavior, if you could do it for yourself, then it would not qualify as a task for your specific disability. A wheelchair might be a help to a person experiencing stiffness from arthritis, but if they are capable of walking on their own, then a wheelchair isn’t really needed. Similarly, a dog trained to remind a handler to take medication, though helpful, would not truly be needed if the person was able to remind themselves to take their medication in ordinary ways, such as using an alarm.

13. If I send CPS an assessment or letter from my personal physician or mental health professional, can that be used in place of the CPS disability assessment so I only pay for the treatment recommendation letter?

No. Because of ethical and legal responsibilities, CPS clinicians are required to base the treatment recommendation letter on our own tests and assessment, rather than depend solely on someone else’s prior findings. So although your documentation from another mental health professional may be factored into the final CPS assessment, our testing and session questions must be completed as the foundation for our diagnosis and assessment.

14. Do you guarantee all domestic airlines and property managers will accept your treatment recommendation letter?

The Fair Housing Amendments Act of 1988 requires property managers and landlords to make a reasonable accommodation (a change in the rules) to permit an emotionally disabled handler to keep an emotional support animal (ESA). That doesn’t mean they won’t inadvertently or intentionally break the law and deny a disabled person the right to have an ESA, however.

Similarly, the Air Carrier Access Act 49 U.S.C. 41705 and Dept of Transportation 14 C.F.R. Part 382 requires airlines to allow a disabled person to be accompanied by their ESA in the cabin of the aircraft and not be charged a fee. Airline companies are allowed to require the disabled passenger to present a treatment recommendation letter from a licensed mental health professional to bring the ESA on board. Several airline companies have been sued and forced to change their practices over the years for arbitrarily electing to discriminate against disabled passengers.

Any company who makes an arbitrary decision without foundation and approval from the U.S. Justice Department is in violation of federal law, and CPS cannot guarantee that any public entity, airline company, or property manager will not willfully or inadvertently break federal law as it regards emotional support animals. Everyone knows that it is illegal to steal a car, but the car thief will continue stealing until he is caught and prosecuted.

Chilhowee Psychological Services is a pioneer in the treatment of disabled clients. We are also the first group of legitimate, licensed mental health professionals who utilize the latest testing and technological modalities to assess, treat, and diagnosis patients online. In addition, our licensed mental health professionals conduct face to face testing, assessment, counseling, and treatment for local patients.