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Here’s how to write an ESA letter for your therapy clients

Learn how to create effective ESA letter templates for your clients, as well as some best practices and legal requirements for them.

June 13, 2025 • Updated on August 29, 2025

By Dr. Anum Ali, LPC

11 min read

By Dr. Anum Ali, LPC

Emotional support animals (ESAs) can play a critical role in helping individuals manage symptoms of anxiety, depression, PTSD, and other mental health conditions. For many clients, these animals provide real, measurable comfort and grounding in their daily lives. But for therapists, the request to write an ESA letter can bring up questions about ethics, legality, and professional scope.

This guide is designed to help you, as a clinician, feel confident and informed when approached for an ESA letter. We'll walk through how to determine eligibility, what to include in a compliant ESA letter, legal guidelines to keep in mind, and how to protect yourself from potential misuse or fraud — plus, you'll find a template to streamline the process.

The therapist’s role in ESA documentation

Your role isn’t to simply approve an ESA request. It’s to assess whether the request is therapeutically appropriate and supported by clinical evidence. As with any clinical decision, your professional judgment and clear documentation are key.

Writing an ESA letter should only occur within the context of an established therapeutic relationship. You must have sufficient knowledge of the client’s mental health status to justify that the animal’s presence alleviates symptoms of a diagnosed condition.

If you do choose to write a letter, your documentation should be rooted in clinical need and defensible if reviewed.

Tips for writing ESA letters

  • Evaluate ESA requests using clinical criteria and diagnostic guidelines.
  • Write letters only for active clients engaged in ongoing therapy.
  • Keep notes on your rationale and conversations about the ESA.
  • Use professional letterhead and include your credentials.
  • Refrain from providing letters for friends, family, or prospective clients after one session.
  • Do not accept payment for the letter — this can present ethical concerns.
  • Avoid using vague or generic templates that don’t reflect the client’s clinical situation.

Legal framework for emotional support animals

While emotional support animals are not considered service animals under the Americans with Disabilities Act (ADA), they are protected under the Fair Housing Act (FHA). This means clients with ESAs are entitled to reasonable accommodations in housing, even in properties with “no pets” policies provided the ESA alleviates symptoms of a documented mental health condition.

The Air Carrier Access Act (ACAA) once provided similar protections, but as of 2021, most airlines have revised their policies to no longer recognize ESAs. Instead, animals must meet service animal criteria to be allowed in the cabin.

Tip: Always review the latest federal and state laws, as guidelines can change.

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Client qualification criteria for ESA approval

Not every client who feels comforted by a pet qualifies for an ESA letter. The decision to provide one must be clinically justified and based on clear criteria.

Before writing a letter, ensure the following conditions are met:

Client ESA eligibility quick checklist

  • Client has a DSM-5 diagnosis that qualifies as a mental or emotional disability
  • The condition substantially limits one or more major life activities
  • The presence of the ESA directly alleviates symptoms or improves functioning
  • Client is actively engaged in treatment with you or your practice

As part of your assessment, consider discussing the client’s functional impairments, how the animal supports them, and whether the ESA is a consistent topic in treatment.

Bonus resource idea: Create your own ESA assessment intake form to guide your evaluation.

Essential components of an effective ESA letter

Your ESA letter should be professional, specific, and legally compliant. Avoid vague language or excessive clinical detail and strive for clarity and purpose.

What to include:

  1. Client's full name and confirmation of a qualifying mental or emotional disability
  2. Your name, credentials, license number, and contact information
  3. Brief statement of therapeutic relationship, including duration
  4. Clinical rationale for the ESA, describing how the animal helps mitigate symptoms
  5. Legal reference, such as the FHA, for housing-related letters
  6. Date, signature, and use of professional letterhead

Example ESA letter

To Whom It May Concern,

I am a licensed clinical social worker (LCSW) currently treating [client name], who I’ve been working with for [time duration]. They meet the diagnostic criteria for a qualifying mental health diagnosis as defined by the DSM-V. The presence of their emotional support dog provides significant therapeutic benefit, including reduction of panic symptoms and improvement in daily functioning. I recommend the animal’s presence as a necessary part of their mental health support under the Fair Housing Act.

Sincerely,

[Your name]

[Your credentials, license number, and contact information]

Common pitfalls when writing ESA letters

Writing ESA letters may seem straightforward, but even experienced therapists can run into trouble if documentation is vague or the relationship is too limited. Documentation should always be strong enough to support your clinical decision if reviewed.

Avoid these common mistakes:

  • Writing letters for clients you’ve only seen once or for intake-only sessions
  • Using boilerplate or one-size-fits-all language
  • Omitting your clinical rationale or diagnostic support
  • Failing to retain a copy in your clinical records

Protecting yourself from ESA letter scams and fraud

Unfortunately, some individuals seek ESA letters for reasons unrelated to mental health, including convenience, financial gain, or circumventing housing policies. It’s important to recognize the red flags and proceed with caution.

Warning signs:

  • The client mentions the ESA before discussing symptoms or treatment
  • Requests come with pressure, urgency, or offers of extra payment
  • The animal is described as exotic or inappropriate for typical ESA accommodations
  • You're approached by a third-party ESA certification company

Trust your clinical instincts. If something feels off, you’re not obligated to proceed and you can always consult with colleagues or refer the individual for a more thorough assessment.

Case examples: Appropriate and inappropriate ESA requests

To clarify what constitutes a clinically valid ESA letter, here are two illustrative examples:

Appropriate request:

 "Jordan has been in treatment for panic disorder for six months. They report that their ESA cat helps ground them during episodes, decreases nighttime anxiety, and is a regular topic in therapy sessions. Clinical notes reflect sustained improvement correlated with the animal’s presence."

Inappropriate request:

"Taylor, a new client seen for one session, requested an ESA letter to avoid a pet deposit at their apartment. No diagnostic work has been completed, and the client has not agreed to ongoing treatment."


In states such as California, ESA letters can only be issued by healthcare professionals who have had an established client-provider relationship for at least 30 days. When in doubt, refer to your ethics code and licensing board guidance.

Headway helps keep your focus on therapy, not admin work

Supporting your clients shouldn’t mean getting bogged down in paperwork or second-guessing documentation. Headway simplifies practice management with built-in clinical templates, streamlined insurance support, and access to trusted therapy tools. Spend more time on therapy and less time on admin as a Headway provider.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

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