You can open the Emotional Support Animal Oregon Letter Template in multiple formats, including PDF, Word, and Google Docs.
Emotional Support Animal Oregon Letter Template Printable | Editable FormSample
Examples
[Name of the Licensed Mental Health Professional]
[License Number]
[Professional Address]
[Phone Number]
[Email]
[Name of the Patient]
[Patient’s Date of Birth]
[Patient’s Address]
This letter serves to certify that [Name of the Patient] has a qualifying condition and requires an emotional support animal (ESA) to assist them in managing their mental health.
[Description of the patient’s mental health condition, e.g., anxiety, depression, PTSD], which affects their daily functioning and quality of life.
It is my professional recommendation that [Name of the Patient] be allowed to have an emotional support animal, as the presence of this animal will provide necessary emotional comfort and support.
Type of Animal: [Specify type, e.g., dog, cat]
Name of Animal: [Name of the ESA if applicable]
[Additional details about the animal’s training or temperament, if relevant]
Under the Fair Housing Act (FHA), individuals with emotional support animals are protected and entitled to reasonable accommodations in housing environments.
This letter is valid for [Duration, e.g., one year] from the date of issuance unless otherwise updated or amended.
[Signature of the Licensed Mental Health Professional]
[Printed Name of the Licensed Mental Health Professional]
[Date]
[Name of the Licensed Therapist or Counselor]
[License Number]
[Professional Address]
[Contact Number]
[Email Address]
[Name of the Patient]
[Patient’s Date of Birth]
[Patient’s Address]
This letter is written to support the need for an emotional support animal for [Name of the Patient], who has been under my care since [Start Date].
The patient has been diagnosed with [Specific Diagnosis] and exhibits symptoms that significantly interfere with their capacity to cope with daily life. The presence of an emotional support animal is crucial for their mental well-being.
[Describe how the patient’s condition limits their daily activities or functioning, elaborating on specific challenges they face which the ESA can alleviate.]
It is advised that [Name of the Patient] be permitted to keep an emotional support animal, as this pet provides necessary therapeutic benefits and support.
Species: [Dog/Cat/etc.]
Breed: [Specify breed, if any]
[Additional behavioral or training information regarding the ESA]
In accordance with federal law, individuals with disabilities are entitled to reasonable accommodations, which include having an emotional support animal in their residency.
This document is effective until [End Date] and should be revisited for any changes in the patient’s condition or housing requirements.
[Signature of the Licensed Therapist or Counselor]
[Printed Name]
[Date]
Format
Please complete the form below to create the Emotional Support Animal Oregon Letter Template. All fields must be filled out to ensure a clear and complete letter. We provide examples to guide you through each step. Emotional Support Animal Oregon Letter Template 1. Medical Professional Information 2. Patient Information 3. Emotional Support Animal Information 4. Purpose of the Letter 5. Description of the Relationship 6. Recommendations for Housing and Travel 7. Duration of Support 8. Signature and Acceptance 9. Declaration and Signatures
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Emotional Support Animal Oregon Letter Template Printable | Editable FormPrintable
