Which type of animal support are you seeking? * Please select ESA or Service Animal Emotional Support Animal (ESA) - $199 Service Animal - $399
Which condition do you experience that may qualify you for an Emotional Support Animal? * Please select ADHD Anxiety Autism Spectrum Bipolar Disorder Depression Eating Disorder General Stress Insomnia OCD Panic Disorder PTSD Schizophrenia Social Isolation
Which condition do you experience that may qualify you for a Service Animal? * Please select Anxiety Bipolar Blindness or vision problems Brain or memory problems Depression Diabetes Hearing problems Heart or circulation issues Intellectual disabilities Mobility problems Nerve or muscle problems OCD PTSD Schizophrenia Seizures Severe allergic reactions Sleep disorders
Do you struggle to stay focused on tasks? * Please select No Occasionally Frequently Always
Do you feel restless or easily distracted? * Please select Never Occasionally Frequently Always
Do you lose or misplace items frequently? * Please select Never Occasionally Frequently Daily
Do you have difficulty with time management or deadlines? * Please select No Occasionally Frequently Always
Do you act impulsively or have trouble controlling your responses? * Please select No Occasionally Frequently Always
Do you struggle to regulate your emotions? * Please select No Occasionally Frequently Always
Do you feel overwhelmed or anxious due to inattentiveness or hyperactivity? * Please select Never Occasionally Frequently Always
Would the presence of an ESA help improve focus, calm, or structure? * Please select Not at all Somewhat Very helpful Critical
Have you ever been advised to seek emotional regulation strategies? * Please select No Yes, casually Yes, professionally Yes, ongoing support
Do you often experience excessive worry that feels difficult to control? * Please select No Occasionally Frequently Severely
Do anxious thoughts interfere with your ability to complete everyday tasks? * Please select No Occasionally Frequently Severely
Do you avoid certain places or situations due to anxiety or nervousness? * Please select No Occasionally Frequently Severely
Do physical symptoms like a racing heart or shortness of breath accompany your anxiety? * Please select No Occasionally Frequently Severely
Do you find it hard to relax or feel “on edge” most of the time? * Please select No Occasionally Frequently Severely
Does your anxiety affect your relationships or social interactions? * Please select No Occasionally Frequently Severely
Do you experience sleep issues (difficulty falling or staying asleep) due to anxiety? * Please select No Occasionally Frequently Severely
Do you need emotional support to feel grounded during anxious episodes? * Please select No Occasionally Frequently Severely
Has your anxiety led to missed days at work, school, or social events? * Please select No Occasionally Frequently Severely
Would having a comforting companion animal help reduce the intensity or frequency of your anxiety symptoms? * Please select No Occasionally Frequently Severely
Do you experience challenges with social communication or understanding social cues? * Please select No Occasionally Frequently Severely
Do changes in routine or environment cause you significant stress or anxiety? * Please select No Occasionally Frequently Severely
Do you engage in repetitive behaviors or have specific rituals that bring comfort? * Please select No Occasionally Frequently Severely
Do you struggle with emotional regulation or calming yourself during distress? * Please select No Occasionally Frequently Severely
Do certain sensory experiences (e.g., loud noises, bright lights) feel overwhelming? * Please select No Occasionally Frequently Severely
Do you often feel isolated or disconnected from others? * Please select No Occasionally Frequently Severely
Would the presence of an emotional support animal help ease social or emotional stress? * Please select No Occasionally Frequently Severely
Do you find that animals help you better navigate emotionally intense situations? * Please select No Occasionally Frequently Severely
Do you feel more secure and calm when accompanied by a familiar animal companion? * Please select No Occasionally Frequently Severely
Do you believe that an ESA could assist in reducing meltdowns, shutdowns, or emotional distress? * Please select No Occasionally Frequently Severely
Do you experience extreme mood swings that impact your daily life? * Please select No Occasionally Frequently Severely
Do periods of elevated mood or energy interfere with your judgment or behavior? * Please select No Occasionally Frequently Severely
Do you have episodes of depression that cause loss of interest or motivation? * Please select No Occasionally Frequently Severely
Do your mood changes affect your ability to maintain relationships or work consistently? * Please select No Occasionally Frequently Severely
Do you struggle with emotional regulation during high or low mood episodes? * Please select No Occasionally Frequently Severely
Do you experience sleep disturbances (e.g., insomnia or excessive sleep) related to mood shifts? * Please select No Occasionally Frequently Severely
Do you feel isolated or disconnected during depressive or manic episodes? * Please select No Occasionally Frequently Severely
Would the consistent presence of an animal help stabilize your emotional state? * Please select No Occasionally Frequently Severely
Do you believe having an emotional support animal could reduce stress during mood fluctuations? * Please select No Occasionally Frequently Severely
Has your provider or therapist ever recommended emotional support to assist with managing your bipolar symptoms? * Please select No Occasionally Frequently Severely
Do you often feel a persistent sense of sadness or emptiness? * Please select No Occasionally Frequently Severely
Do you experience a loss of interest in activities you once enjoyed? * Please select No Occasionally Frequently Severely
Do you have difficulty getting out of bed or starting your day due to low mood? * Please select No Occasionally Frequently Severely
Do you struggle with feelings of hopelessness or worthlessness? * Please select No Occasionally Frequently Severely
Do you find it hard to concentrate or make decisions because of your mood? * Please select No Occasionally Frequently Severely
Do you experience changes in appetite or weight related to your mood? * Please select No Occasionally Frequently Severely
Do you isolate yourself or avoid social interaction because of depression? * Please select No Occasionally Frequently Severely
Would the companionship of an animal provide comfort during depressive episodes? * Please select No Occasionally Frequently Severely
Do you believe having an emotional support animal could motivate you to stay active or engaged? * Please select No Occasionally Frequently Severely
Has your depression interfered with your work, school, or home responsibilities? * Please select No Occasionally Frequently Severely
Do you experience distressing thoughts about food, weight, or body image? * Please select No Occasionally Frequently Severely
Do you engage in restrictive eating, binging, or purging behaviors? * Please select No Occasionally Frequently Severely
Do you feel a lack of control over your eating habits? * Please select No Occasionally Frequently Severely
Does your relationship with food negatively impact your daily functioning? * Please select No Occasionally Frequently Severely
Do you avoid social situations involving food due to anxiety or shame? * Please select No Occasionally Frequently Severely
Do you struggle with feelings of guilt, anxiety, or depression after eating? * Please select No Occasionally Frequently Severely
Do you experience extreme changes in weight or physical health due to eating behaviors? * Please select No Occasionally Frequently Severely
Would the presence of an emotional support animal help reduce your anxiety or distress related to food? * Please select No Occasionally Frequently Severely
Do you feel comforted or emotionally supported by animals during times of disordered eating behavior? * Please select No Occasionally Frequently Severely
Has a healthcare provider recommended additional emotional support to assist with your eating disorder recovery? * Please select No Occasionally Frequently Severely
Do you often feel overwhelmed by the demands of daily life? * Please select No Occasionally Frequently Severely
Do you experience physical symptoms (e.g., headaches, muscle tension) when stressed? * Please select No Occasionally Frequently Severely
Do you have trouble relaxing or unwinding after a stressful event? * Please select No Occasionally Frequently Severely
Do you feel mentally or emotionally drained after a day of work or social interactions? * Please select No Occasionally Frequently Severely
Do you find it difficult to manage your responsibilities due to constant stress? * Please select No Occasionally Frequently Severely
Do you experience sleep disturbances due to stress or anxiety? * Please select No Occasionally Frequently Severely
Do you often feel anxious or worried about upcoming events or situations? * Please select No Occasionally Frequently Severely
Would the presence of an emotional support animal help you feel more grounded during stressful times? * Please select No Occasionally Frequently Severely
Do you believe an ESA could reduce your stress levels and help you relax? * Please select No Occasionally Frequently Severely
Have you sought or considered professional help for managing stress in your daily life? * Please select No Occasionally Frequently Severely
Do you have difficulty falling asleep at night? * Please select No Occasionally Frequently Severely
Do you wake up frequently during the night and have trouble falling back asleep? * Please select No Occasionally Frequently Severely
Do you feel unrested or fatigued during the day due to poor sleep quality? * Please select No Occasionally Frequently Severely
Do you experience racing thoughts that prevent you from relaxing before bed? * Please select No Occasionally Frequently Severely
Do you struggle with staying asleep throughout the night without waking up prematurely? * Please select No Occasionally Frequently Severely
Do you rely on sleep aids or medication to help you fall asleep? * Please select No Occasionally Frequently Severely
Does poor sleep or insomnia affect your ability to function at work or in social settings? * Please select No Occasionally Frequently Severely
Would having an emotional support animal help you feel more relaxed and fall asleep easier? * Please select No Occasionally Frequently Severely
Do you feel comforted or calmed by the presence of an animal during the night? * Please select No Occasionally Frequently Severely
Have you sought professional help to address your insomnia or sleep difficulties? * Please select No Occasionally Frequently Severely
Do you experience intrusive, unwanted thoughts that cause significant anxiety or distress? * Please select No Occasionally Frequently Severely
Do you feel compelled to perform specific rituals or behaviors to reduce anxiety or prevent something bad from happening? * Please select No Occasionally Frequently Severely
Do your compulsions interfere with your daily life or routine? * Please select No Occasionally Frequently Severely
Do you spend a significant amount of time each day on rituals or repetitive behaviors? * Please select No Occasionally Frequently Severely
Do you feel unable to control or stop your obsessive thoughts or compulsive behaviors, even though you want to? * Please select No Occasionally Frequently Severely
Do you experience significant anxiety when unable to perform a compulsion? * Please select No Occasionally Frequently Severely
Do you find that your obsessions or compulsions affect your work, relationships, or social life? * Please select No Occasionally Frequently Severely
Would the presence of an emotional support animal help reduce your anxiety or compulsive urges? * Please select No Occasionally Frequently Severely
Do you believe an ESA could provide emotional comfort and grounding during moments of distress related to your OCD? * Please select No Occasionally Frequently Severely
Have you sought or are you currently seeking therapy or medication to help manage your OCD symptoms? * Please select No Occasionally Frequently Severely
Do you experience sudden and unexpected feelings of intense fear or anxiety? * Please select No Occasionally Frequently Severely
Do you have physical symptoms during a panic attack, such as rapid heartbeat, shortness of breath, or dizziness? * Please select No Occasionally Frequently Severely
Do you worry about having another panic attack, leading to avoidance of certain places or situations? * Please select No Occasionally Frequently Severely
Do you feel as though you’re losing control or “going crazy” during a panic attack? * Please select No Occasionally Frequently Severely
Do panic attacks interfere with your ability to work, socialize, or engage in everyday activities? * Please select No Occasionally Frequently Severely
Do you feel emotionally drained or overwhelmed after experiencing a panic attack? * Please select No Occasionally Frequently Severely
Do you experience feelings of detachment or unreality during or after a panic attack? * Please select No Occasionally Frequently Severely
Would the presence of an emotional support animal help reduce the severity of your panic attacks? * Please select No Occasionally Frequently Severely
Do you believe that having an ESA could provide comfort and emotional grounding during moments of intense fear or anxiety? * Please select No Occasionally Frequently Severely
Have you sought or are you currently receiving treatment for panic disorder, such as therapy or medication? * Please select No Occasionally Frequently Severely
Do you experience flashbacks or intrusive memories related to a traumatic event? * Please select No Occasionally Frequently Severely
Do you avoid situations, places, or people that remind you of the trauma? * Please select No Occasionally Frequently Severely
Do you experience nightmares or disturbed sleep related to the trauma? * Please select No Occasionally Frequently Severely
Do you feel emotionally numb, detached, or disconnected from others due to past trauma? * Please select No Occasionally Frequently Severely
Do you feel constantly on edge or easily startled? * Please select No Occasionally Frequently Severely
Do you struggle with feelings of guilt, shame, or hopelessness as a result of your traumatic experience? * Please select No Occasionally Frequently Severely
Do you experience difficulty concentrating or remembering things, especially during stressful moments? * Please select No Occasionally Frequently Severely
Would having an emotional support animal help you manage feelings of anxiety, hypervigilance, or emotional distress related to PTSD? * Please select No Occasionally Frequently Severely
Do you believe an ESA could help provide comfort and grounding during moments of heightened stress or flashbacks? * Please select No Occasionally Frequently Severely
Have you sought or are you currently receiving therapy or medication for PTSD symptoms? * Please select No Occasionally Frequently Severely
Do you experience hallucinations, such as hearing voices or seeing things that aren't there? * Please select No Occasionally Frequently Severely
Do you experience delusions, such as believing things that aren't based in reality (e.g., thinking you're being watched or controlled)? * Please select No Occasionally Frequently Severely
Do you have difficulty distinguishing between what is real and what is not during certain episodes? * Please select No Occasionally Frequently Severely
Do you find it hard to maintain coherent or logical conversations due to disorganized thinking? * Please select No Occasionally Frequently Severely
Do you experience periods of emotional numbness or detachment from reality? * Please select No Occasionally Frequently Severely
Do you struggle with social interactions or maintaining relationships due to your symptoms? * Please select No Occasionally Frequently Severely
Do you often feel confused or disoriented, even in familiar settings? * Please select No Occasionally Frequently Severely
Would having an emotional support animal provide comfort or emotional grounding during periods of distress or confusion? * Please select No Occasionally Frequently Severely
Do you believe an ESA could help alleviate symptoms such as anxiety, paranoia, or emotional instability? * Please select No Occasionally Frequently Severely
Have you sought or are you currently receiving treatment, such as medication or therapy, for your schizophrenia symptoms? * Please select No Occasionally Frequently Severely
Do you find yourself withdrawing from social activities or avoiding social situations? * Please select No Occasionally Frequently Severely
Do you feel lonely or disconnected from others, even when you're around people? * Please select No Occasionally Frequently Severely
Do you struggle to maintain friendships or relationships due to a lack of social interaction? * Please select No Occasionally Frequently Severely
Do you feel misunderstood or unable to relate to others? * Please select No Occasionally Frequently Severely
Do you often feel like you don’t have anyone to talk to or share your feelings with? * Please select No Occasionally Frequently Severely
Do you experience feelings of sadness or emptiness due to a lack of social connection? * Please select No Occasionally Frequently Severely
Do you tend to isolate yourself at home or avoid leaving the house to prevent social interaction? * Please select No Occasionally Frequently Severely
Would the presence of an emotional support animal provide comfort and help reduce feelings of loneliness? * Please select No Occasionally Frequently Severely
Do you believe having an ESA could motivate you to engage more with the outside world or people? * Please select No Occasionally Frequently Severely
Have you considered or received professional help to address feelings of social isolation or loneliness? * Please select No Occasionally Frequently Severely
How often do you experience excessive worry or fear in everyday situations? * Please select No Occasionally Frequently Severely
How often do you feel restless or on edge? * Please select No Occasionally Frequently Severely
How often do you experience physical symptoms like a racing heart or shortness of breath when anxious? * Please select No Occasionally Frequently Severely
How often do you avoid places or situations because they make you anxious? * Please select No Occasionally Frequently Severely
How often do you experience panic attacks or intense feelings of fear? * Please select No Occasionally Frequently Severely
How much does anxiety affect your ability to concentrate or focus? * Please select No Occasionally Frequently Severely
How often do you feel overwhelmed by anxiety? * Please select No Occasionally Frequently Severely
How much does anxiety impact your ability to engage in social or work settings? * Please select No Occasionally Frequently Severely
How much do you believe that a service animal could help reduce your anxiety symptoms? * Please select No Occasionally Frequently Severely
How often do you experience mood swings, ranging from feelings of extreme euphoria to deep depression? * Please select No Occasionally Frequently Severely
How often do you feel impulsive or engage in risky behaviors during periods of mania or hypomania? * Please select No Occasionally Frequently Severely
How often do you feel irritable or easily frustrated during mood shifts? * Please select No Occasionally Frequently Severely
How often do you experience racing thoughts or difficulty concentrating during manic episodes? * Please select No Occasionally Frequently Severely
How much do your mood swings interfere with your daily activities and responsibilities? * Please select No Occasionally Frequently Severely
How often do you feel emotionally exhausted or overwhelmed after a manic or depressive episode? * Please select No Occasionally Frequently Severely
How much does your bipolar disorder affect your ability to maintain relationships or social connections? * Please select No Occasionally Frequently Severely
How often do you experience periods of low energy, sadness, or hopelessness during depressive episodes? * Please select No Occasionally Frequently Severely
How much do you believe a service animal could help manage the symptoms of your bipolar disorder? * Please select No Occasionally Frequently Severely
How often do you feel that your bipolar disorder limits your ability to function in work or social situations? * Please select No Occasionally Frequently Severely
How often do you experience difficulty navigating unfamiliar places due to vision problems? * Please select No Occasionally Frequently Severely
How much does your vision impairment impact your ability to perform daily tasks like cooking, cleaning, or shopping? * Please select No Occasionally Frequently Severely
How often do you rely on others for assistance with activities due to your vision issues? * Please select No Occasionally Frequently Severely
How often do you feel unsafe or disoriented in unfamiliar environments due to your vision impairment? * Please select No Occasionally Frequently Severely
How much would a service animal help you in safely navigating public spaces or your home? * Please select No Occasionally Frequently Severely
How often do you feel limited in your independence due to your vision impairment? * Please select No Occasionally Frequently Severely
How much do vision problems affect your ability to engage in social or recreational activities? * Please select No Occasionally Frequently Severely
How often do you experience difficulty with reading or recognizing objects or people? * Please select No Occasionally Frequently Severely
How much do you believe that a service animal could improve your ability to safely move through your environment? * Please select No Occasionally Frequently Severely
How often do you require assistance from a guide or other support services due to vision loss? * Please select No Occasionally Frequently Severely
How often do you experience forgetfulness or memory lapses in daily activities? * Please select No Occasionally Frequently Severely
How much do brain or memory problems interfere with your ability to perform tasks at work or home? * Please select No Occasionally Frequently Severely
How often do you struggle with recalling important dates, names, or appointments? * Please select No Occasionally Frequently Severely
How much do you rely on reminders or assistance from others due to memory difficulties? * Please select No Occasionally Frequently Severely
How often do you find yourself feeling disoriented or confused in unfamiliar environments? * Please select Never Occasionally Frequently Severely
How much does forgetfulness impact your social interactions or relationships? * Please select Not at all Occasionally Frequently Severely
How often do you feel overwhelmed by difficulty remembering instructions or important details? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could help you stay organized or assist with memory-related tasks? * Please select Not at all Occasionally Frequently Severely
How often do you experience difficulty following conversations or maintaining focus due to cognitive challenges? * Please select Never Occasionally Frequently Severely
How much do brain or memory issues impact your independence or daily living activities? * Please select Not at all Occasionally Frequently Severely
How often do you feel sad, hopeless, or down for extended periods of time? * Please select Never Occasionally Frequently Severely
How much does depression affect your ability to perform daily tasks like getting out of bed, eating, or bathing? * Please select Not at all Occasionally Frequently Severely
How often do you lose interest in activities that you once enjoyed? * Please select Never Occasionally Frequently Severely
How much do feelings of worthlessness or guilt impact your thoughts or actions? * Please select Never Occasionally Frequently Severely
How often do you experience difficulty concentrating or making decisions due to your depression? * Please select Never Occasionally Frequently Severely
How much do depressive symptoms affect your ability to engage socially or maintain relationships? * Please select None Occasionally Frequently Severely
How often do you feel fatigued or lack energy, even after resting? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could provide emotional support and help improve your mood? * Please select None Occasionally Frequently Severely
How often do you experience changes in appetite or sleep patterns (eating too much, too little, or difficulty sleeping)? * Please select Never Occasionally Frequently Severely
How much does depression affect your ability to participate in work, school, or social activities? * Please select Not at all Occasionally Frequently Severely
How often do you experience fluctuations in your blood sugar levels that require immediate attention? * Please select Never Occasionally Frequently Severely
How much do you rely on monitoring your blood sugar levels throughout the day to manage your diabetes? * Please select None Occasionally Frequently Severely
How often do you experience symptoms of low blood sugar, such as shaking, sweating, or dizziness? * Please select Never Occasionally Frequently Severely
How much do these blood sugar fluctuations impact your ability to perform daily tasks or go about your routine? * Please select None Occasionally Frequently Severely
How often do you feel fatigued or weak due to your blood sugar being too high or too low? * Please select Never Occasionally Frequently Severely
How much does managing your diabetes interfere with your ability to participate in social or recreational activities? * Please select None Occasionally Frequently Severely
How often do you experience feelings of confusion or difficulty thinking clearly when your blood sugar is off balance? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could assist in alerting you to blood sugar changes or helping with emergency situations? * Please select None Occasionally Frequently Severely
How often do you require assistance from others to monitor or manage your diabetes, especially during episodes of high or low blood sugar? * Please select Never Occasionally Frequently Severely
How much does your diabetes impact your independence or ability to carry out your daily responsibilities? * Please select Never Occasionally Frequently Severely
How often do you have difficulty hearing important sounds or signals, such as alarms, doorbells, or sirens? * Please select Never Occasionally Frequently Severely
How much does hearing impairment affect your ability to communicate effectively in social or work settings? * Please select Never Occasionally Frequently Severely
How often do you miss conversations or verbal cues, even when in close proximity to the speaker? * Please select Never Occasionally Frequently Severely
How much do you rely on others to alert you to important sounds or events, such as phone calls or notifications? * Please select Never Occasionally Frequently Severely
How often do you experience difficulty hearing people on the phone or in noisy environments? * Please select Never Occasionally Frequently Severely
How much do hearing problems interfere with your ability to participate in social or professional activities? * Please select Never Occasionally Frequently Severely
How often do you feel unsafe or unaware of your surroundings due to hearing difficulties, especially in public places? * Please select Never Occasionally Frequently Severely
How much would a service animal help you by alerting you to sounds or helping with communication in various situations? * Please select None Occasionally Frequently Severely
How often do you feel isolated or disconnected because of your hearing difficulties? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could assist you in improving safety and independence by alerting you to sounds you may not hear? * Please select Never Occasionally Frequently Severely
How often do you experience shortness of breath, dizziness, or fatigue due to heart or circulation issues? * Please select Never Occasionally Frequently Severely
How much do your heart or circulation problems affect your ability to perform daily tasks or physical activities? * Please select Never Occasionally Frequently Severely
How often do you experience chest pain or discomfort that limits your ability to engage in normal activities? * Please select Never Occasionally Frequently Severely
How much do these heart or circulation issues impact your mobility or ability to walk long distances? * Please select Never Occasionally Frequently Severely
How often do you experience swelling in your legs, feet, or ankles as a result of circulation problems? * Please select Never Occasionally Frequently Severely
How much does the concern over your heart or circulation issues affect your confidence or mental well-being? * Please select Never Occasionally Frequently Severely
How often do you need to stop physical activities due to feeling lightheaded or faint? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could help you by providing support or alerting you in case of an emergency related to your heart or circulation? * Please select Never Occasionally Frequently Severely
How often do you require assistance from others to manage symptoms related to heart or circulation issues, such as taking medication or resting? * Please select Never Occasionally Frequently Severely
How much do heart or circulation issues affect your ability to participate in social or work activities? * Please select Never Occasionally Frequently Severely
How often do you struggle with understanding or processing complex instructions or tasks? * Please select Never Occasionally Frequently Severely
How much do intellectual disabilities affect your ability to remember important information, like appointments or tasks? * Please select Never Occasionally Frequently Severely
How often do you feel confused or overwhelmed by everyday tasks or decisions? * Please select Never Occasionally Frequently Severely
How much do you rely on others to help with organizing or completing daily activities? * Please select Never Occasionally Frequently Severely
How often do you experience difficulty with problem-solving or decision-making in everyday situations? * Please select Never Occasionally Frequently Severely
How much do your intellectual disabilities affect your ability to live independently or manage your personal life? * Please select Never Occasionally Frequently Severely
How often do you need assistance with managing finances, appointments, or other routine responsibilities? * Please select Never Occasionally Frequently Severely
How much would a service animal help you by providing support in managing daily tasks or offering emotional support? * Please select Never Occasionally Frequently Severely
How often do you feel anxious or frustrated due to difficulties with understanding or processing information? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could improve your ability to stay focused or on task in various situations? * Please select Never Occasionally Frequently Severely
How often do you experience difficulty walking or standing for long periods of time? * Please select Never Occasionally Frequently Severely
How much do mobility problems affect your ability to get around in public spaces or your home? * Please select Never Occasionally Frequently Severely
How often do you experience pain, discomfort, or fatigue when walking or using mobility aids (e.g., cane, walker)? * Please select Never Occasionally Frequently Severely
How much do your mobility issues prevent you from performing tasks such as grocery shopping, running errands, or carrying heavy items? * Please select Never Occasionally Frequently Severely
How often do you require assistance from others when navigating stairs, uneven surfaces, or crowded areas? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could assist you in maintaining balance or preventing falls during daily activities? * Please select Never Occasionally Frequently Severely
How often do you find yourself needing to take breaks or rest during physical activities due to mobility issues? * Please select Never Occasionally Frequently Severely
How much would a service animal help you by providing support in standing, walking, or navigating your environment? * Please select Never Occasionally Frequently Severely
How often do you feel unsafe or vulnerable due to your mobility limitations, especially in unfamiliar or public places? * Please select Never Occasionally Frequently Severely
How much do mobility problems impact your ability to maintain an independent lifestyle or participate in social activities? * Please select Never Occasionally Frequently Severely
How often do you experience muscle weakness, stiffness, or fatigue due to nerve or muscle problems? * Please select Never Occasionally Frequently Severely
How much do nerve or muscle problems affect your ability to perform daily tasks such as dressing, eating, or bathing? * Please select Never Occasionally Frequently Severely
How often do you experience pain, tingling, or numbness in your muscles or nerves? * Please select Never Occasionally Frequently Severely
How much do your nerve or muscle problems impact your ability to walk, stand, or sit for extended periods? * Please select Never Occasionally Frequently Severely
How often do you experience difficulty with fine motor tasks, such as holding objects or writing? * Please select Never Occasionally Frequently Severely
How much do you rely on assistive devices (e.g., braces, walkers, crutches) to manage nerve or muscle issues? * Please select Never Occasionally Frequently Severely
How often do you need assistance from others when performing physical tasks due to muscle or nerve problems? * Please select Never Occasionally Frequently Severely
How much would a service animal help you by providing support or assistance with balance, mobility, or muscle function? * Please select Never Occasionally Frequently Severely
How often do you experience sudden or unexpected muscle spasms, cramps, or loss of coordination? * Please select Never Occasionally Frequently Severely
How much do nerve or muscle problems affect your overall quality of life and ability to participate in social or work activities? * Please select Never Occasionally Frequently Severely
How often do you experience intrusive thoughts or obsessive worries that are difficult to control? * Please select Never Occasionally Frequently Severely
How much do compulsive behaviors (such as washing, checking, or arranging) interfere with your daily routine? * Please select Never Occasionally Frequently Severely
How often do you feel the need to perform rituals or repetitive actions to reduce anxiety or prevent something bad from happening? * Please select Never Occasionally Frequently Severely
How much do your OCD symptoms affect your ability to focus on tasks at work, school, or home? * Please select Never Occasionally Frequently Severely
How often do you feel distressed, anxious, or overwhelmed by your obsessions or compulsions? * Please select Never Occasionally Frequently Severely
How much do your OCD symptoms affect your social interactions or relationships with others? * Please select Never Occasionally Frequently Severely
How often do you engage in compulsive behaviors, such as repeating tasks or actions, to alleviate anxiety or stress? * Please select Never Occasionally Frequently Severely
How much would a service animal help by providing calming support or redirecting you during moments of anxiety or compulsions? * Please select Never Occasionally Frequently Severely
How often do your OCD symptoms cause you to feel exhausted or emotionally drained due to the repetitive nature of your thoughts or actions? * Please select Never Occasionally Frequently Severely
How much do you believe a service animal could help reduce your overall anxiety and make it easier to manage OCD symptoms in daily life? * Please select Never Occasionally Frequently Severely
How often do you experience flashbacks or intrusive memories related to a traumatic event? * Please select Never Occasionally Frequently Severely
How much do feelings of anxiety, fear, or panic affect your daily life or interactions with others? * Please select Never Occasionally Frequently Severely
How often do you experience nightmares or difficulty sleeping due to PTSD-related stress? * Please select Never Occasionally Frequently Severely
How much do you struggle with feelings of detachment or numbness, especially in social situations? * Please select Never Occasionally Frequently Severely
How often do you feel hypervigilant, on edge, or easily startled by sounds or movements? * Please select Never Occasionally Frequently Severely
How much do PTSD symptoms interfere with your ability to concentrate, focus, or complete tasks? * Please select Never Occasionally Frequently Severely
How often do you experience avoidance behaviors, such as avoiding places, people, or activities that remind you of a traumatic event? * Please select Never Occasionally Frequently Severely
How much would a service animal help you manage anxiety, provide emotional support, or assist you during times of distress or hypervigilance? * Please select Never Occasionally Frequently Severely
How often do you feel emotionally overwhelmed or disconnected from others due to PTSD symptoms? * Please select Never Occasionally Frequently Severely
How much do PTSD-related symptoms impact your relationships with family, friends, or coworkers? * Please select Never Occasionally Frequently Severely
How often do you experience auditory or visual hallucinations (e.g., hearing voices or seeing things that others do not)? * Please select Never Occasionally Frequently Severely
How much do these hallucinations affect your ability to function in daily activities or interact with others? * Please select Never Occasionally Frequently Severely
How often do you have difficulty distinguishing between reality and thoughts or delusions? * Please select Never Occasionally Frequently Severely
How much do delusional thoughts or beliefs impact your relationships or social interactions? * Please select Never Occasionally Frequently Severely
How often do you feel disconnected from your emotions or have difficulty expressing yourself? * Please select Never Occasionally Frequently Severely
How much does your condition interfere with your ability to complete tasks or focus on work or school? * Please select Never Occasionally Frequently Severely
How often do you experience periods of confusion, disorganization, or difficulty thinking clearly? * Please select Never Occasionally Frequently Severely
How much would a service animal help you manage symptoms such as anxiety, confusion, or feeling overwhelmed during episodes? * Please select Never Occasionally Frequently Severely
How often do you experience social withdrawal or difficulty maintaining relationships due to your symptoms? * Please select Never Occasionally Frequently Severely
How much do you feel that having a service animal could provide emotional stability and assistance during moments of distress or confusion? * Please select Never Occasionally Frequently Severely
How often do you experience seizures, whether they are focal, generalized, or another type? * Please select Never Occasionally Frequently Severely
How much do you rely on others to help you during or after a seizure? * Please select Never Occasionally Frequently Severely
How often do you experience warning signs or auras before a seizure occurs? * Please select Never Occasionally Frequently Severely
How much do you worry about having a seizure in public or in situations where help may not be immediately available? * Please select Never Occasionally Frequently Severely
How often do you feel anxious, fearful, or stressed about the possibility of having a seizure? * Please select Never Occasionally Frequently Severely
How much would a service animal help by alerting you to an impending seizure or providing support during or after a seizure? * Please select Never Occasionally Frequently Severely
How often do you experience physical discomfort or confusion following a seizure? * Please select Never Occasionally Frequently Severely
How much do your seizures impact your ability to perform everyday activities such as driving, working, or going to social events? * Please select Never Occasionally Frequently Severely
How often do you experience seizures despite taking medication or following a treatment plan? * Please select Never Occasionally Frequently Severely
How much do you believe having a service animal would improve your sense of security and independence when living with seizures? * Please select Never Occasionally Frequently Severely
How often do you experience severe allergic reactions, such as anaphylaxis, to specific allergens (e.g., food, insects, pollen)? * Please select Never Occasionally Frequently Severely
How much do you worry about experiencing a severe allergic reaction in public or in situations where help may not be immediately available? * Please select Never Occasionally Frequently Severely
How often do you need to carry emergency medication, such as an epinephrine injector (EpiPen), to manage potential allergic reactions? * Please select Never Occasionally Frequently Severely
How much does the fear of an allergic reaction affect your ability to participate in everyday activities or social events? * Please select Never Occasionally Frequently Severely
How often do you experience symptoms such as swelling, difficulty breathing, or dizziness as a result of an allergic reaction? * Please select Never Occasionally Frequently Severely
How much would a service animal help by alerting you to potential allergens in your environment or notifying you during an allergic reaction? * Please select Never Occasionally Frequently Severely
How often do you require assistance from others during or after a severe allergic reaction? * Please select Never Occasionally Frequently Severely
How much do allergic reactions impact your confidence in managing your health independently? * Please select Never Occasionally Frequently Severely
How often do you avoid certain environments or activities due to the risk of an allergic reaction? * Please select Never Occasionally Frequently Severely
How much do you believe having a service animal would improve your ability to manage your allergies and help you feel more secure in daily situations? * Please select Never Occasionally Frequently Severely
How often do you have difficulty falling asleep or staying asleep throughout the night? * Please select Never Occasionally Frequently Severely
How much do sleep disturbances, such as insomnia or frequent awakenings, impact your ability to function during the day? * Please select Never Occasionally Frequently Severely
How often do you experience excessive daytime sleepiness or fatigue due to poor sleep quality? * Please select Never Occasionally Frequently Severely
How much does sleep deprivation affect your mood, concentration, or ability to complete daily tasks? * Please select Never Occasionally Frequently Severely
How often do you experience restless legs, vivid dreams, or nightmares that disrupt your sleep? * Please select Never Occasionally Frequently Severely
How much do you rely on medication or other treatments to help you manage sleep issues? * Please select Never Occasionally Frequently Severely
How often do you find yourself feeling anxious or stressed about your inability to get a restful night’s sleep? * Please select Never Occasionally Frequently Severely
How much would a service animal help you feel more relaxed or secure, especially if you experience night terrors, sleepwalking, or anxiety during sleep? * Please select Never Occasionally Frequently Severely
How often do you wake up feeling unrefreshed or still tired after a full night of sleep? * Please select Never Occasionally Frequently Severely
How much do you believe having a service animal would improve your sleep quality by providing comfort or reducing anxiety during the night? * Please select Never Occasionally Frequently Severely
