Online Medical Exam | Online Emotional Support Animal Approval & Prescriptions

Online Exam Form

Step 1 of 7

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The exam below is a Psychological assessment evaluation and is comprised of 7 steps that are all required to be completed. It should take about 30 minutes to finish the exam. You must prepare yourself to complete the entire exam from start to finish, as there will be no way of saving your work and coming back to it later. Therefore, if you are not prepared to finish it in its entirety, please come back again when you have enough time to complete it. This exam is also MOBILE FRIENDLY so you will be able to use your phone if need be. Once you hit submit and complete your exam, please allow no longer than 2 business days for the mental health professional who reviews it to contact you with your results. If you are not approved, you will receive a same-day 100% refund.
Part I: Personal Information
First Name*
Last Name*
Date of Birth*
Street Address*
Phone Number*
Email*
City*
*
Zip Code*
Gender*
- Male
- Female
How did you hear about us?*
If selected other, please specify:
What's your current occupation? Please write your current occupation or if unemployed or a student please explain,*
Marital Status*
- Married
- Single
- Divorced
- Widowed
Preferred Emotional Support Pet*
- Dog
- Cat
(Please specify if wanting more than one pet in the "other" box. Payment MUST be made for each pet, EX: 2 dogs)
PLEASE CONFIRM THE INFORMATION ABOVE REGARDING SPELLING OF YOUR NAME, DATE OF BIRTH, EMAIL ADDRESS, AND GENDER ARE ENTERED AND SPELLED CORRECTLY. ANY ERRORS WILL CAUSE COMPLICATIONS WITH THE APPROVAL PROCESS AND IF APPROVED, THERE WILL BE A $25 CHANGE/ EDIT FEE.

Online Exam Form

Step 1 of 7

Part I: Personal Information

Section 2: General and Mental Health

Section 3: General Medical History:

Section 4: Major Depression

Section 5: Generalized Anxiety & Panic Disorder

Section 6: Post Traumatic Stress Disorder

Section 7: SOCIAL PHOBIAS