Take Our ESA and Service Animal Quiz – Instant Online Evaluation Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 4Let's start with some basic information Name *FirstLastEmail *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone *Do you currently reside in Florida? *Please selectYesNoYou must reside in Florida full-time or seasonally to use our services.NextSave and Resume Later Please answer some questions so we make sure you qualify Which type of animal support are you seeking? *Please select ESA or Service AnimalEmotional Support Animal (ESA) - $199Service Animal - $399Which condition do you experience that may qualify you for an Emotional Support Animal? *Please selectADHDAnxietyAutism SpectrumBipolar DisorderDepressionEating DisorderGeneral StressInsomniaOCDPanic DisorderPTSDSchizophreniaSocial IsolationWhich condition do you experience that may qualify you for a Service Animal? *Please selectAnxietyBipolarBlindness or vision problemsBrain or memory problemsDepressionDiabetesHearing problemsHeart or circulation issuesIntellectual disabilitiesMobility problemsNerve or muscle problemsOCDPTSDSchizophreniaSeizuresSevere allergic reactionsSleep disordersDo you struggle to stay focused on tasks? *Please select NoOccasionallyFrequentlyAlwaysDo you feel restless or easily distracted? *Please selectNeverOccasionallyFrequentlyAlwaysDo you lose or misplace items frequently? *Please selectNeverOccasionallyFrequentlyDailyDo you have difficulty with time management or deadlines? *Please selectNoOccasionallyFrequentlyAlwaysDo you act impulsively or have trouble controlling your responses? *Please selectNoOccasionallyFrequentlyAlwaysDo you struggle to regulate your emotions? *Please selectNoOccasionallyFrequentlyAlwaysDo you feel overwhelmed or anxious due to inattentiveness or hyperactivity? *Please selectNeverOccasionallyFrequentlyAlwaysWould the presence of an ESA help improve focus, calm, or structure? *Please selectNot at allSomewhatVery helpfulCriticalHave you ever been advised to seek emotional regulation strategies? *Please selectNoYes, casuallyYes, professionallyYes, ongoing supportDo you often experience excessive worry that feels difficult to control? *Please selectNoOccasionallyFrequentlySeverelyDo anxious thoughts interfere with your ability to complete everyday tasks? *Please selectNoOccasionallyFrequentlySeverelyDo you avoid certain places or situations due to anxiety or nervousness? *Please selectNoOccasionallyFrequentlySeverelyDo physical symptoms like a racing heart or shortness of breath accompany your anxiety? *Please selectNoOccasionallyFrequentlySeverelyDo you find it hard to relax or feel “on edge” most of the time? *Please selectNoOccasionallyFrequentlySeverelyDoes your anxiety affect your relationships or social interactions? *Please selectNoOccasionallyFrequentlySeverelyDo you experience sleep issues (difficulty falling or staying asleep) due to anxiety? *Please selectNoOccasionallyFrequentlySeverelyDo you need emotional support to feel grounded during anxious episodes? *Please selectNoOccasionallyFrequentlySeverelyHas your anxiety led to missed days at work, school, or social events? *Please selectNoOccasionallyFrequentlySeverelyWould having a comforting companion animal help reduce the intensity or frequency of your anxiety symptoms? *Please selectNoOccasionallyFrequentlySeverelyDo you experience challenges with social communication or understanding social cues? *Please selectNoOccasionallyFrequentlySeverelyDo changes in routine or environment cause you significant stress or anxiety? *Please selectNoOccasionallyFrequentlySeverelyDo you engage in repetitive behaviors or have specific rituals that bring comfort? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle with emotional regulation or calming yourself during distress? *Please selectNoOccasionallyFrequentlySeverelyDo certain sensory experiences (e.g., loud noises, bright lights) feel overwhelming? *Please selectNoOccasionallyFrequentlySeverelyDo you often feel isolated or disconnected from others? *Please selectNoOccasionallyFrequentlySeverelyWould the presence of an emotional support animal help ease social or emotional stress? *Please selectNoOccasionallyFrequentlySeverelyDo you find that animals help you better navigate emotionally intense situations? *Please selectNoOccasionallyFrequentlySeverelyDo you feel more secure and calm when accompanied by a familiar animal companion? *Please selectNoOccasionallyFrequentlySeverelyDo you believe that an ESA could assist in reducing meltdowns, shutdowns, or emotional distress? *Please selectNoOccasionallyFrequentlySeverelyDo you experience extreme mood swings that impact your daily life? *Please selectNoOccasionallyFrequentlySeverelyDo periods of elevated mood or energy interfere with your judgment or behavior? *Please selectNoOccasionallyFrequentlySeverelyDo you have episodes of depression that cause loss of interest or motivation? *Please selectNoOccasionallyFrequentlySeverelyDo your mood changes affect your ability to maintain relationships or work consistently? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle with emotional regulation during high or low mood episodes? *Please selectNoOccasionallyFrequentlySeverelyDo you experience sleep disturbances (e.g., insomnia or excessive sleep) related to mood shifts? *Please selectNoOccasionallyFrequentlySeverelyDo you feel isolated or disconnected during depressive or manic episodes? *Please selectNoOccasionallyFrequentlySeverelyWould the consistent presence of an animal help stabilize your emotional state? *Please selectNoOccasionallyFrequentlySeverelyDo you believe having an emotional support animal could reduce stress during mood fluctuations? *Please selectNoOccasionallyFrequentlySeverelyHas your provider or therapist ever recommended emotional support to assist with managing your bipolar symptoms? *Please selectNoOccasionallyFrequentlySeverelyDo you often feel a persistent sense of sadness or emptiness? *Please selectNoOccasionallyFrequentlySeverelyDo you experience a loss of interest in activities you once enjoyed? *Please selectNoOccasionallyFrequentlySeverelyDo you have difficulty getting out of bed or starting your day due to low mood? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle with feelings of hopelessness or worthlessness? *Please selectNoOccasionallyFrequentlySeverelyDo you find it hard to concentrate or make decisions because of your mood? *Please selectNoOccasionallyFrequentlySeverelyDo you experience changes in appetite or weight related to your mood? *Please selectNoOccasionallyFrequentlySeverelyDo you isolate yourself or avoid social interaction because of depression? *Please selectNoOccasionallyFrequentlySeverelyWould the companionship of an animal provide comfort during depressive episodes? *Please selectNoOccasionallyFrequentlySeverelyDo you believe having an emotional support animal could motivate you to stay active or engaged? *Please selectNoOccasionallyFrequentlySeverelyHas your depression interfered with your work, school, or home responsibilities? *Please selectNoOccasionallyFrequentlySeverelyDo you experience distressing thoughts about food, weight, or body image? *Please selectNoOccasionallyFrequentlySeverelyDo you engage in restrictive eating, binging, or purging behaviors? *Please selectNoOccasionallyFrequentlySeverelyDo you feel a lack of control over your eating habits? *Please selectNoOccasionallyFrequentlySeverelyDoes your relationship with food negatively impact your daily functioning? *Please selectNoOccasionallyFrequentlySeverelyDo you avoid social situations involving food due to anxiety or shame? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle with feelings of guilt, anxiety, or depression after eating? *Please selectNoOccasionallyFrequentlySeverelyDo you experience extreme changes in weight or physical health due to eating behaviors? *Please selectNoOccasionallyFrequentlySeverelyWould the presence of an emotional support animal help reduce your anxiety or distress related to food? *Please selectNoOccasionallyFrequentlySeverelyDo you feel comforted or emotionally supported by animals during times of disordered eating behavior? *Please selectNoOccasionallyFrequentlySeverelyHas a healthcare provider recommended additional emotional support to assist with your eating disorder recovery? *Please selectNoOccasionallyFrequentlySeverelyDo you often feel overwhelmed by the demands of daily life? *Please selectNoOccasionallyFrequentlySeverelyDo you experience physical symptoms (e.g., headaches, muscle tension) when stressed? *Please selectNoOccasionallyFrequentlySeverelyDo you have trouble relaxing or unwinding after a stressful event? *Please selectNoOccasionallyFrequentlySeverelyDo you feel mentally or emotionally drained after a day of work or social interactions? *Please selectNoOccasionallyFrequentlySeverelyDo you find it difficult to manage your responsibilities due to constant stress? *Please selectNoOccasionallyFrequentlySeverelyDo you experience sleep disturbances due to stress or anxiety? *Please selectNoOccasionallyFrequentlySeverelyDo you often feel anxious or worried about upcoming events or situations? *Please selectNoOccasionallyFrequentlySeverelyWould the presence of an emotional support animal help you feel more grounded during stressful times? *Please selectNoOccasionallyFrequentlySeverelyDo you believe an ESA could reduce your stress levels and help you relax? *Please selectNoOccasionallyFrequentlySeverelyHave you sought or considered professional help for managing stress in your daily life? *Please selectNoOccasionallyFrequentlySeverelyDo you have difficulty falling asleep at night? *Please selectNoOccasionallyFrequentlySeverelyDo you wake up frequently during the night and have trouble falling back asleep? *Please selectNoOccasionallyFrequentlySeverelyDo you feel unrested or fatigued during the day due to poor sleep quality? *Please selectNoOccasionallyFrequentlySeverelyDo you experience racing thoughts that prevent you from relaxing before bed? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle with staying asleep throughout the night without waking up prematurely? *Please selectNoOccasionallyFrequentlySeverelyDo you rely on sleep aids or medication to help you fall asleep? *Please selectNoOccasionallyFrequentlySeverelyDoes poor sleep or insomnia affect your ability to function at work or in social settings? *Please selectNoOccasionallyFrequentlySeverelyWould having an emotional support animal help you feel more relaxed and fall asleep easier? *Please selectNoOccasionallyFrequentlySeverelyDo you feel comforted or calmed by the presence of an animal during the night? *Please selectNoOccasionallyFrequentlySeverelyHave you sought professional help to address your insomnia or sleep difficulties? *Please selectNoOccasionallyFrequentlySeverelyDo you experience intrusive, unwanted thoughts that cause significant anxiety or distress? *Please selectNoOccasionallyFrequentlySeverelyDo you feel compelled to perform specific rituals or behaviors to reduce anxiety or prevent something bad from happening? *Please selectNoOccasionallyFrequentlySeverelyDo your compulsions interfere with your daily life or routine? *Please selectNoOccasionallyFrequentlySeverelyDo you spend a significant amount of time each day on rituals or repetitive behaviors? *Please selectNoOccasionallyFrequentlySeverelyDo you feel unable to control or stop your obsessive thoughts or compulsive behaviors, even though you want to? *Please selectNoOccasionallyFrequentlySeverelyDo you experience significant anxiety when unable to perform a compulsion? *Please selectNoOccasionallyFrequentlySeverelyDo you find that your obsessions or compulsions affect your work, relationships, or social life? *Please selectNoOccasionallyFrequentlySeverelyWould the presence of an emotional support animal help reduce your anxiety or compulsive urges? *Please selectNoOccasionallyFrequentlySeverelyDo you believe an ESA could provide emotional comfort and grounding during moments of distress related to your OCD? *Please selectNoOccasionallyFrequentlySeverelyHave you sought or are you currently seeking therapy or medication to help manage your OCD symptoms? *Please selectNoOccasionallyFrequentlySeverelyDo you experience sudden and unexpected feelings of intense fear or anxiety? *Please selectNoOccasionallyFrequentlySeverelyDo you have physical symptoms during a panic attack, such as rapid heartbeat, shortness of breath, or dizziness? *Please selectNoOccasionallyFrequentlySeverelyDo you worry about having another panic attack, leading to avoidance of certain places or situations? *Please selectNoOccasionallyFrequentlySeverelyDo you feel as though you’re losing control or “going crazy” during a panic attack? *Please selectNoOccasionallyFrequentlySeverelyDo panic attacks interfere with your ability to work, socialize, or engage in everyday activities? *Please selectNoOccasionallyFrequentlySeverelyDo you feel emotionally drained or overwhelmed after experiencing a panic attack? *Please selectNoOccasionallyFrequentlySeverelyDo you experience feelings of detachment or unreality during or after a panic attack? *Please selectNoOccasionallyFrequentlySeverelyWould the presence of an emotional support animal help reduce the severity of your panic attacks? *Please selectNoOccasionallyFrequentlySeverelyDo you believe that having an ESA could provide comfort and emotional grounding during moments of intense fear or anxiety? *Please selectNoOccasionallyFrequentlySeverelyHave you sought or are you currently receiving treatment for panic disorder, such as therapy or medication? *Please selectNoOccasionallyFrequentlySeverelyDo you experience flashbacks or intrusive memories related to a traumatic event? *Please selectNoOccasionallyFrequentlySeverelyDo you avoid situations, places, or people that remind you of the trauma? *Please selectNoOccasionallyFrequentlySeverelyDo you experience nightmares or disturbed sleep related to the trauma? *Please selectNoOccasionallyFrequentlySeverelyDo you feel emotionally numb, detached, or disconnected from others due to past trauma? *Please selectNoOccasionallyFrequentlySeverelyDo you feel constantly on edge or easily startled? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle with feelings of guilt, shame, or hopelessness as a result of your traumatic experience? *Please selectNoOccasionallyFrequentlySeverelyDo you experience difficulty concentrating or remembering things, especially during stressful moments? *Please selectNoOccasionallyFrequentlySeverelyWould having an emotional support animal help you manage feelings of anxiety, hypervigilance, or emotional distress related to PTSD? *Please selectNoOccasionallyFrequentlySeverelyDo you believe an ESA could help provide comfort and grounding during moments of heightened stress or flashbacks? *Please selectNoOccasionallyFrequentlySeverelyHave you sought or are you currently receiving therapy or medication for PTSD symptoms? *Please selectNoOccasionallyFrequentlySeverelyDo you experience hallucinations, such as hearing voices or seeing things that aren't there? *Please selectNoOccasionallyFrequentlySeverelyDo you experience delusions, such as believing things that aren't based in reality (e.g., thinking you're being watched or controlled)? *Please selectNoOccasionallyFrequentlySeverelyDo you have difficulty distinguishing between what is real and what is not during certain episodes? *Please selectNoOccasionallyFrequentlySeverelyDo you find it hard to maintain coherent or logical conversations due to disorganized thinking? *Please selectNoOccasionallyFrequentlySeverelyDo you experience periods of emotional numbness or detachment from reality? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle with social interactions or maintaining relationships due to your symptoms? *Please selectNoOccasionallyFrequentlySeverelyDo you often feel confused or disoriented, even in familiar settings? *Please selectNoOccasionallyFrequentlySeverelyWould having an emotional support animal provide comfort or emotional grounding during periods of distress or confusion? *Please selectNoOccasionallyFrequentlySeverelyDo you believe an ESA could help alleviate symptoms such as anxiety, paranoia, or emotional instability? *Please selectNoOccasionallyFrequentlySeverelyHave you sought or are you currently receiving treatment, such as medication or therapy, for your schizophrenia symptoms? *Please selectNoOccasionallyFrequentlySeverelyDo you find yourself withdrawing from social activities or avoiding social situations? *Please selectNoOccasionallyFrequentlySeverelyDo you feel lonely or disconnected from others, even when you're around people? *Please selectNoOccasionallyFrequentlySeverelyDo you struggle to maintain friendships or relationships due to a lack of social interaction? *Please selectNoOccasionallyFrequentlySeverelyDo you feel misunderstood or unable to relate to others? *Please selectNoOccasionallyFrequentlySeverelyDo you often feel like you don’t have anyone to talk to or share your feelings with? *Please selectNoOccasionallyFrequentlySeverelyDo you experience feelings of sadness or emptiness due to a lack of social connection? *Please selectNoOccasionallyFrequentlySeverelyDo you tend to isolate yourself at home or avoid leaving the house to prevent social interaction? *Please selectNoOccasionallyFrequentlySeverelyWould the presence of an emotional support animal provide comfort and help reduce feelings of loneliness? *Please selectNoOccasionallyFrequentlySeverelyDo you believe having an ESA could motivate you to engage more with the outside world or people? *Please selectNoOccasionallyFrequentlySeverelyHave you considered or received professional help to address feelings of social isolation or loneliness? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience excessive worry or fear in everyday situations? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel restless or on edge? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience physical symptoms like a racing heart or shortness of breath when anxious? *Please selectNoOccasionallyFrequentlySeverelyHow often do you avoid places or situations because they make you anxious? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience panic attacks or intense feelings of fear? *Please selectNoOccasionallyFrequentlySeverelyHow much does anxiety affect your ability to concentrate or focus? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel overwhelmed by anxiety? *Please selectNoOccasionallyFrequentlySeverelyHow much does anxiety impact your ability to engage in social or work settings? *Please selectNoOccasionallyFrequentlySeverelyHow much do you believe that a service animal could help reduce your anxiety symptoms? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience mood swings, ranging from feelings of extreme euphoria to deep depression? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel impulsive or engage in risky behaviors during periods of mania or hypomania? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel irritable or easily frustrated during mood shifts? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience racing thoughts or difficulty concentrating during manic episodes? *Please selectNoOccasionallyFrequentlySeverelyHow much do your mood swings interfere with your daily activities and responsibilities? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel emotionally exhausted or overwhelmed after a manic or depressive episode? *Please selectNoOccasionallyFrequentlySeverelyHow much does your bipolar disorder affect your ability to maintain relationships or social connections? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience periods of low energy, sadness, or hopelessness during depressive episodes? *Please selectNoOccasionallyFrequentlySeverelyHow much do you believe a service animal could help manage the symptoms of your bipolar disorder? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel that your bipolar disorder limits your ability to function in work or social situations? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience difficulty navigating unfamiliar places due to vision problems? *Please selectNoOccasionallyFrequentlySeverelyHow much does your vision impairment impact your ability to perform daily tasks like cooking, cleaning, or shopping? *Please selectNoOccasionallyFrequentlySeverelyHow often do you rely on others for assistance with activities due to your vision issues? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel unsafe or disoriented in unfamiliar environments due to your vision impairment? *Please selectNoOccasionallyFrequentlySeverelyHow much would a service animal help you in safely navigating public spaces or your home? *Please selectNoOccasionallyFrequentlySeverelyHow often do you feel limited in your independence due to your vision impairment? *Please selectNoOccasionallyFrequentlySeverelyHow much do vision problems affect your ability to engage in social or recreational activities? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience difficulty with reading or recognizing objects or people? *Please selectNoOccasionallyFrequentlySeverelyHow much do you believe that a service animal could improve your ability to safely move through your environment? *Please selectNoOccasionallyFrequentlySeverelyHow often do you require assistance from a guide or other support services due to vision loss? *Please selectNoOccasionallyFrequentlySeverelyHow often do you experience forgetfulness or memory lapses in daily activities? *Please selectNoOccasionallyFrequentlySeverelyHow much do brain or memory problems interfere with your ability to perform tasks at work or home? *Please selectNoOccasionallyFrequentlySeverelyHow often do you struggle with recalling important dates, names, or appointments? *Please selectNoOccasionallyFrequentlySeverelyHow much do you rely on reminders or assistance from others due to memory difficulties? *Please selectNoOccasionallyFrequentlySeverelyHow often do you find yourself feeling disoriented or confused in unfamiliar environments? *Please selectNeverOccasionallyFrequentlySeverelyHow much does forgetfulness impact your social interactions or relationships? *Please selectNot at allOccasionallyFrequentlySeverelyHow often do you feel overwhelmed by difficulty remembering instructions or important details? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you believe a service animal could help you stay organized or assist with memory-related tasks? *Please selectNot at allOccasionallyFrequentlySeverelyHow often do you experience difficulty following conversations or maintaining focus due to cognitive challenges? *Please selectNeverOccasionallyFrequentlySeverelyHow much do brain or memory issues impact your independence or daily living activities? *Please selectNot at allOccasionallyFrequentlySeverelyHow often do you feel sad, hopeless, or down for extended periods of time? *Please selectNeverOccasionallyFrequentlySeverelyHow much does depression affect your ability to perform daily tasks like getting out of bed, eating, or bathing? *Please selectNot at allOccasionallyFrequentlySeverelyHow often do you lose interest in activities that you once enjoyed? *Please selectNeverOccasionallyFrequentlySeverelyHow much do feelings of worthlessness or guilt impact your thoughts or actions? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience difficulty concentrating or making decisions due to your depression? *Please selectNeverOccasionallyFrequentlySeverelyHow much do depressive symptoms affect your ability to engage socially or maintain relationships? *Please selectNoneOccasionallyFrequentlySeverelyHow often do you feel fatigued or lack energy, even after resting? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you believe a service animal could provide emotional support and help improve your mood? *Please selectNoneOccasionallyFrequentlySeverelyHow often do you experience changes in appetite or sleep patterns (eating too much, too little, or difficulty sleeping)? *Please selectNeverOccasionallyFrequentlySeverelyHow much does depression affect your ability to participate in work, school, or social activities? *Please selectNot at allOccasionallyFrequentlySeverelyHow often do you experience fluctuations in your blood sugar levels that require immediate attention? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you rely on monitoring your blood sugar levels throughout the day to manage your diabetes? *Please selectNoneOccasionallyFrequentlySeverelyHow often do you experience symptoms of low blood sugar, such as shaking, sweating, or dizziness? *Please selectNeverOccasionallyFrequentlySeverelyHow much do these blood sugar fluctuations impact your ability to perform daily tasks or go about your routine? *Please selectNoneOccasionallyFrequentlySeverelyHow often do you feel fatigued or weak due to your blood sugar being too high or too low? *Please selectNeverOccasionallyFrequentlySeverelyHow much does managing your diabetes interfere with your ability to participate in social or recreational activities? *Please selectNoneOccasionallyFrequentlySeverelyHow often do you experience feelings of confusion or difficulty thinking clearly when your blood sugar is off balance? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you believe a service animal could assist in alerting you to blood sugar changes or helping with emergency situations? *Please selectNoneOccasionallyFrequentlySeverelyHow often do you require assistance from others to monitor or manage your diabetes, especially during episodes of high or low blood sugar? *Please selectNeverOccasionallyFrequentlySeverelyHow much does your diabetes impact your independence or ability to carry out your daily responsibilities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you have difficulty hearing important sounds or signals, such as alarms, doorbells, or sirens? *Please selectNeverOccasionallyFrequentlySeverelyHow much does hearing impairment affect your ability to communicate effectively in social or work settings? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you miss conversations or verbal cues, even when in close proximity to the speaker? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you rely on others to alert you to important sounds or events, such as phone calls or notifications? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience difficulty hearing people on the phone or in noisy environments? *Please selectNeverOccasionallyFrequentlySeverelyHow much do hearing problems interfere with your ability to participate in social or professional activities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel unsafe or unaware of your surroundings due to hearing difficulties, especially in public places? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help you by alerting you to sounds or helping with communication in various situations? *Please selectNoneOccasionallyFrequentlySeverelyHow often do you feel isolated or disconnected because of your hearing difficulties? *Please selectNeverOccasionallyFrequentlySeverelyHow 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 selectNeverOccasionallyFrequentlySeverelyHow often do you experience shortness of breath, dizziness, or fatigue due to heart or circulation issues? *Please selectNeverOccasionallyFrequentlySeverelyHow much do your heart or circulation problems affect your ability to perform daily tasks or physical activities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience chest pain or discomfort that limits your ability to engage in normal activities? *Please selectNeverOccasionallyFrequentlySeverelyHow much do these heart or circulation issues impact your mobility or ability to walk long distances? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience swelling in your legs, feet, or ankles as a result of circulation problems? *Please selectNeverOccasionallyFrequentlySeverelyHow much does the concern over your heart or circulation issues affect your confidence or mental well-being? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you need to stop physical activities due to feeling lightheaded or faint? *Please selectNeverOccasionallyFrequentlySeverelyHow 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 selectNeverOccasionallyFrequentlySeverelyHow often do you require assistance from others to manage symptoms related to heart or circulation issues, such as taking medication or resting? *Please selectNeverOccasionallyFrequentlySeverelyHow much do heart or circulation issues affect your ability to participate in social or work activities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you struggle with understanding or processing complex instructions or tasks? *Please selectNeverOccasionallyFrequentlySeverelyHow much do intellectual disabilities affect your ability to remember important information, like appointments or tasks? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel confused or overwhelmed by everyday tasks or decisions? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you rely on others to help with organizing or completing daily activities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience difficulty with problem-solving or decision-making in everyday situations? *Please selectNeverOccasionallyFrequentlySeverelyHow much do your intellectual disabilities affect your ability to live independently or manage your personal life? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you need assistance with managing finances, appointments, or other routine responsibilities? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help you by providing support in managing daily tasks or offering emotional support? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel anxious or frustrated due to difficulties with understanding or processing information? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you believe a service animal could improve your ability to stay focused or on task in various situations? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience difficulty walking or standing for long periods of time? *Please selectNeverOccasionallyFrequentlySeverelyHow much do mobility problems affect your ability to get around in public spaces or your home? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience pain, discomfort, or fatigue when walking or using mobility aids (e.g., cane, walker)? *Please selectNeverOccasionallyFrequentlySeverelyHow much do your mobility issues prevent you from performing tasks such as grocery shopping, running errands, or carrying heavy items? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you require assistance from others when navigating stairs, uneven surfaces, or crowded areas? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you believe a service animal could assist you in maintaining balance or preventing falls during daily activities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you find yourself needing to take breaks or rest during physical activities due to mobility issues? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help you by providing support in standing, walking, or navigating your environment? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel unsafe or vulnerable due to your mobility limitations, especially in unfamiliar or public places? *Please selectNeverOccasionallyFrequentlySeverelyHow much do mobility problems impact your ability to maintain an independent lifestyle or participate in social activities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience muscle weakness, stiffness, or fatigue due to nerve or muscle problems? *Please selectNeverOccasionallyFrequentlySeverelyHow much do nerve or muscle problems affect your ability to perform daily tasks such as dressing, eating, or bathing? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience pain, tingling, or numbness in your muscles or nerves? *Please selectNeverOccasionallyFrequentlySeverelyHow much do your nerve or muscle problems impact your ability to walk, stand, or sit for extended periods? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience difficulty with fine motor tasks, such as holding objects or writing? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you rely on assistive devices (e.g., braces, walkers, crutches) to manage nerve or muscle issues? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you need assistance from others when performing physical tasks due to muscle or nerve problems? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help you by providing support or assistance with balance, mobility, or muscle function? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience sudden or unexpected muscle spasms, cramps, or loss of coordination? *Please selectNeverOccasionallyFrequentlySeverelyHow much do nerve or muscle problems affect your overall quality of life and ability to participate in social or work activities? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience intrusive thoughts or obsessive worries that are difficult to control? *Please selectNeverOccasionallyFrequentlySeverelyHow much do compulsive behaviors (such as washing, checking, or arranging) interfere with your daily routine? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel the need to perform rituals or repetitive actions to reduce anxiety or prevent something bad from happening? *Please selectNeverOccasionallyFrequentlySeverelyHow much do your OCD symptoms affect your ability to focus on tasks at work, school, or home? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel distressed, anxious, or overwhelmed by your obsessions or compulsions? *Please selectNeverOccasionallyFrequentlySeverelyHow much do your OCD symptoms affect your social interactions or relationships with others? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you engage in compulsive behaviors, such as repeating tasks or actions, to alleviate anxiety or stress? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help by providing calming support or redirecting you during moments of anxiety or compulsions? *Please selectNeverOccasionallyFrequentlySeverelyHow often do your OCD symptoms cause you to feel exhausted or emotionally drained due to the repetitive nature of your thoughts or actions? *Please selectNeverOccasionallyFrequentlySeverelyHow 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 selectNeverOccasionallyFrequentlySeverelyHow often do you experience flashbacks or intrusive memories related to a traumatic event? *Please selectNeverOccasionallyFrequentlySeverelyHow much do feelings of anxiety, fear, or panic affect your daily life or interactions with others? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience nightmares or difficulty sleeping due to PTSD-related stress? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you struggle with feelings of detachment or numbness, especially in social situations? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel hypervigilant, on edge, or easily startled by sounds or movements? *Please selectNeverOccasionallyFrequentlySeverelyHow much do PTSD symptoms interfere with your ability to concentrate, focus, or complete tasks? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience avoidance behaviors, such as avoiding places, people, or activities that remind you of a traumatic event? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help you manage anxiety, provide emotional support, or assist you during times of distress or hypervigilance? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel emotionally overwhelmed or disconnected from others due to PTSD symptoms? *Please selectNeverOccasionallyFrequentlySeverelyHow much do PTSD-related symptoms impact your relationships with family, friends, or coworkers? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience auditory or visual hallucinations (e.g., hearing voices or seeing things that others do not)? *Please selectNeverOccasionallyFrequentlySeverelyHow much do these hallucinations affect your ability to function in daily activities or interact with others? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you have difficulty distinguishing between reality and thoughts or delusions? *Please selectNeverOccasionallyFrequentlySeverelyHow much do delusional thoughts or beliefs impact your relationships or social interactions? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel disconnected from your emotions or have difficulty expressing yourself? *Please selectNeverOccasionallyFrequentlySeverelyHow much does your condition interfere with your ability to complete tasks or focus on work or school? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience periods of confusion, disorganization, or difficulty thinking clearly? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help you manage symptoms such as anxiety, confusion, or feeling overwhelmed during episodes? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience social withdrawal or difficulty maintaining relationships due to your symptoms? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you feel that having a service animal could provide emotional stability and assistance during moments of distress or confusion? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience seizures, whether they are focal, generalized, or another type? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you rely on others to help you during or after a seizure? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience warning signs or auras before a seizure occurs? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you worry about having a seizure in public or in situations where help may not be immediately available? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you feel anxious, fearful, or stressed about the possibility of having a seizure? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help by alerting you to an impending seizure or providing support during or after a seizure? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience physical discomfort or confusion following a seizure? *Please selectNeverOccasionallyFrequentlySeverelyHow much do your seizures impact your ability to perform everyday activities such as driving, working, or going to social events? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience seizures despite taking medication or following a treatment plan? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you believe having a service animal would improve your sense of security and independence when living with seizures? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience severe allergic reactions, such as anaphylaxis, to specific allergens (e.g., food, insects, pollen)? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you worry about experiencing a severe allergic reaction in public or in situations where help may not be immediately available? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you need to carry emergency medication, such as an epinephrine injector (EpiPen), to manage potential allergic reactions? *Please selectNeverOccasionallyFrequentlySeverelyHow much does the fear of an allergic reaction affect your ability to participate in everyday activities or social events? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience symptoms such as swelling, difficulty breathing, or dizziness as a result of an allergic reaction? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help by alerting you to potential allergens in your environment or notifying you during an allergic reaction? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you require assistance from others during or after a severe allergic reaction? *Please selectNeverOccasionallyFrequentlySeverelyHow much do allergic reactions impact your confidence in managing your health independently? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you avoid certain environments or activities due to the risk of an allergic reaction? *Please selectNeverOccasionallyFrequentlySeverelyHow 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 selectNeverOccasionallyFrequentlySeverelyHow often do you have difficulty falling asleep or staying asleep throughout the night? *Please selectNeverOccasionallyFrequentlySeverelyHow much do sleep disturbances, such as insomnia or frequent awakenings, impact your ability to function during the day? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience excessive daytime sleepiness or fatigue due to poor sleep quality? *Please selectNeverOccasionallyFrequentlySeverelyHow much does sleep deprivation affect your mood, concentration, or ability to complete daily tasks? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you experience restless legs, vivid dreams, or nightmares that disrupt your sleep? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you rely on medication or other treatments to help you manage sleep issues? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you find yourself feeling anxious or stressed about your inability to get a restful night’s sleep? *Please selectNeverOccasionallyFrequentlySeverelyHow much would a service animal help you feel more relaxed or secure, especially if you experience night terrors, sleepwalking, or anxiety during sleep? *Please selectNeverOccasionallyFrequentlySeverelyHow often do you wake up feeling unrefreshed or still tired after a full night of sleep? *Please selectNeverOccasionallyFrequentlySeverelyHow much do you believe having a service animal would improve your sleep quality by providing comfort or reducing anxiety during the night? *Please selectNeverOccasionallyFrequentlySeverelyNextSave and Resume Later Just a few more questions, almost done Would a service animal help you manage your symptoms or condition? *Please selectYesNoWould having a service animal help you engage more in social or public activities? *Please selectYesNoDo you experience situations where a trained service animal could assist you? *Please selectYesNoWould a service animal improve your quality of life? *Please selectYesNoDo you think an ESA could help you feel more motivated or engaged in daily life? *Please selectYesNoWould an emotional support animal help reduce symptoms related to your mental health condition? *Please selectYesNoDo you believe having an emotional support animal would provide you with comfort or companionship? *Please selectYesNoHave you ever relied on a pet or animal to help manage difficult emotions? *Please selectYesNoNextSave and Resume Later Last step, lets get your certification ready Pet's Name *Type of Service Animal *DogMiniature HorsePet's Breed *Type of Pet and/or Breed *Profile Photo for your Pet * Drag & Drop Files, Choose Files to Upload Profile Photo of yourself * Drag & Drop Files, Choose Files to Upload I confirm that the information I have provided is accurate and truthful. I consent to receiving my ESA or service animal certification letter electronically and understand that Florida Pet Certification will issue my letter based on this information. *I agree.SubmitSave and Resume Later Save and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link