The biggest gap between what people expect from an ESA evaluation and what actually happens is the conversation itself. A lot of people show up expecting a quick form, a 90-second checklist, and a letter in their inbox. What they get instead is a real clinical conversation with a real nurse practitioner who is trying to form an honest professional opinion about whether ESA documentation is appropriate in their specific situation.
This article walks through what that process actually looks like at Veritas, step by step, so there are no surprises. I am Jezwah Harris -- nurse practitioner, lawyer, founder of Veritas Behavioral Group. I have personally done several hundred of these evaluations. Here is the inside view.
Step 0: Before you start, decide if this is the right time
Before you even hit the intake form, it is worth a quick gut check. An ESA evaluation is appropriate if:
- You are 18 or older.
- You live in one of the 17 states Veritas serves (AZ, CA, CO, DE, FL, ID, IL, KS, MA, NV, NM, NY, TX, UT, VT, WA, WY).
- You live with, or have a concrete plan to live with, a companion animal that helps you manage a mental-health condition.
- You are in housing where ESA documentation would solve a real problem -- a no-pet rule, pet fees, breed restrictions, or similar.
- You can have a 30 to 45 minute video conversation about your situation.
- You are not in active crisis. (If you are, please call or text 988 first.)
If those are all true, the evaluation is the right next step.
Step 1: Intake (5 to 10 minutes online)
You start at vbgesa.com and complete a basic intake form. This is identification and address information, not clinical questions. We need:
- First and last name
- Date of birth
- Mailing address (used to confirm state of residence and to address the letter properly)
- Phone and email
- The state you live in (must be one of the 17 we serve -- if you live elsewhere, the form will tell you we cannot serve you and we will not take your money)
- Acknowledgment of the refund policy: the $99 fee is for the clinician's evaluation, regardless of outcome, and is non-refundable once the evaluation is rendered
The intake takes about 5 to 10 minutes. There are no clinical questions at this stage, no diagnostic checklists, no symptoms to report.
Step 2: Payment ($99 via Stripe)
After the intake is complete, you go through Stripe Checkout to pay the $99 evaluation fee. Stripe handles the payment processing -- we do not store your card details.
The fee is the same regardless of state, regardless of condition, and regardless of outcome. There are no upsells. There are no add-ons. There is no "registration fee" for your animal (no such thing exists). There is no premium tier. The $99 covers everything.
A note about the fee structure: the reason we charge $99 instead of $29 is that the evaluation is real. A 30 to 45 minute video conversation with a licensed nurse practitioner, plus the clinician's review and decision time, plus the letter preparation if appropriate, costs more than $29 in actual labor. We are not the most expensive licensed practice; we are not the cheapest. We try to be honest about what the work costs.
Step 3: Clinical questionnaire (10 to 15 minutes online)
After payment, you complete a structured clinical questionnaire. This is more substantial than the intake. The questionnaire includes:
- GAD-7 (Generalized Anxiety Disorder 7-item scale) -- a validated, widely-used screening instrument for anxiety. Seven questions, each scored 0 to 3.
- PHQ-9 (Patient Health Questionnaire 9-item) -- a validated, widely-used screening instrument for depression. Nine questions, each scored 0 to 3.
- History section -- structured questions about your mental-health history, prior care (if any), current medications (if any), the animal in your situation and how long you have lived with them, your housing context, and any other relevant background.
- Animal information -- species, name, approximate age, how long you have had the animal, basic temperament (this is not a "training" assessment -- we are gathering background, not evaluating the animal).
The questionnaire is your record. The clinician reads it before your appointment. Honest, complete answers help the clinician form a real opinion. Inflated or rehearsed answers do not help -- experienced clinicians can usually tell when the answers are calibrated to "pass."
Step 4: Schedule your video appointment
Once the questionnaire is complete, you choose a time for your video appointment with a Veritas nurse practitioner. Most slots are available within 24 to 72 hours of completing the questionnaire. The appointment is 30 to 45 minutes long.
The platform is a HIPAA-compliant secure video service (we use Doxy.me or similar; the link comes via email). You do not need to install software; the appointment runs in your browser.
A few things to know about scheduling:
- California and Florida appointments are subject to the 30-day relationship rule (AB 468 in California, 760.27 in Florida). Your first appointment establishes the relationship; the letter cannot be issued until 30 days have passed. We disclose this clearly during the California and Florida intakes.
- Other states have no waiting period. The appointment can happen as soon as scheduling allows, and the letter (if appropriate) can be delivered within 24 to 48 hours after the appointment.
- Reschedules are allowed up to 24 hours before the appointment. No-shows or last-minute cancellations may result in additional scheduling delay.
Step 5: The video appointment (30 to 45 minutes)
This is the actual evaluation. A few things will set the tone before we get into the clinical part:
- The clinician introduces themselves, confirms your identity, and confirms the state you live in.
- The clinician explains what the evaluation is and is not -- it is an evaluation for ESA documentation under the federal Fair Housing Act, it is not a comprehensive mental-health diagnostic intake, it is not crisis care.
- The clinician explains that they will form a professional opinion based on the conversation, that they may decide to issue a letter or to decline, and that the $99 fee covers the evaluation regardless.
Then the conversation begins. Topics typically covered:
Your day-to-day picture
The clinician asks about your current functioning -- sleep, energy, motivation, work or school, relationships, what is hard, what is working. This is conversational, not a checklist. The clinician is listening for the texture of how a mental-health condition shows up in your life.
Your history
How long have you been managing this? When did it start? What has changed over time? Have you been in care? What has helped, what has not? Family history of mental-health conditions (if known)?
You are not required to disclose specific diagnoses if you are uncomfortable doing so -- the FHA evaluation can proceed on functional descriptions alone -- but most people do share some history naturally as part of the conversation.
The animal
Tell me about your animal. How long have you had them? What is their name and species? How does the animal fit into your day? When you are having a hard day, what is the animal doing? When the animal is not around (a vet visit, a trip), what is different?
This is the most ESA-specific part of the conversation. The clinician is listening for specific, repeatable mechanisms -- not "I love my pet" (which is true for almost everyone with a pet), but the specific role the animal plays in helping you manage the condition.
Housing context
What is the housing situation? What rule are you trying to address (no-pet policy, pet fees, breed restriction, condo board, university housing)? What conversations have you already had with the landlord? Are there any complicating factors (recent move, lease renewal coming up, dispute history)?
Open questions
Toward the end, the clinician usually asks if there is anything else you want to share, anything they have not asked that you think is relevant, or any questions you have about the process or the letter itself.
Step 6: The clinician's decision
After the appointment, the clinician reviews the full file -- intake, questionnaire, screening scores, conversation -- and forms a professional opinion. Three possible outcomes:
A. The clinician issues the letter
In the majority of cases, the clinical picture supports ESA documentation, and the clinician issues a letter. The letter is on the clinician's letterhead, includes the clinician's full credentials and license number, includes the language required by your state's law (e.g., AB 468 disclosure language for California letters), and is delivered as a signed PDF within 24 to 48 hours of the appointment (or, in California and Florida, at or after the 30-day mark).
The letter does not include your specific diagnosis. HUD guidance and most state laws explicitly do not require disclosure of the diagnosis to the housing provider, so we do not include it.
B. The clinician declines, with explanation
In a meaningful minority of cases, the clinical picture does not support an ESA letter, and the clinician declines to issue one. The clinician will explain why in writing. Common reasons:
- The functional impact described does not rise to a "substantially limits a major life activity" picture under the FHA.
- The animal does not appear to be playing the kind of specific, repeatable role that supports ESA documentation.
- The patient appears to be in active crisis and needs higher-level care first.
- The patient does not have an animal yet and the timing is premature.
- The housing situation does not actually require an ESA letter (e.g., already in a pet-friendly building with no fees).
The fee is not refunded -- the evaluation happened, the clinician spent time and judgment, and the work is what you paid for. We know this is hard to hear when the answer is no, and we wish we could give a better outcome, but the model only works if the answer is honest. We cover this in detail in What Happens If My Clinician Decides Not to Issue an ESA Letter?.
C. The clinician requests additional information
Less common, but it happens. The clinician may need additional context -- a second appointment, a follow-up question, additional time -- before forming an opinion. In those cases, the clinician explains what is needed and the next step happens within the same evaluation (no additional fee).
Step 7: Letter delivery and use
If the clinician issues the letter, you receive a signed PDF via email, typically within 24 to 48 hours of the appointment (subject to state waiting periods). The letter includes:
- Veritas Behavioral Group letterhead
- The clinician's full name, license type, license number, and state of licensure
- A statement that you have a condition meeting the FHA definition of disability
- A statement that an emotional support animal is part of your treatment or support plan
- The animal's species and name (if you provided it)
- The date of issuance
- The clinician's signature
You then submit the letter to your landlord, condo board, university housing office, or other housing provider, along with a written reasonable-accommodation request. We have a separate guide on what to do if your landlord pushes back.
Step 8: After the letter
The letter is conventionally good for about 12 months in most states (with some state-specific variations). When you reach the 12-month mark, or when you move, or when you sign a new lease, a fresh evaluation is typically the right call. We cover the renewal logic in ESA Letter Renewal: When and Why You Need a Fresh Evaluation.
If you have follow-up questions about the letter, your landlord's response, or the documentation itself, you can email us at esa@vbgesa.com. We do not provide ongoing legal representation, but we can answer reasonable follow-up questions about the documentation we issued.
How long does the whole thing take?
End to end, the typical timeline:
- Texas, Arizona, Colorado, Idaho, Illinois, Kansas, Massachusetts, Nevada, New Mexico, New York, Utah, Vermont, Washington, Wyoming, Delaware: intake to letter, 2 to 5 business days from intake start, depending on appointment scheduling.
- California: intake to letter, 30+ days from intake (AB 468 30-day relationship rule).
- Florida: intake to letter, 30+ days from intake (Fla Stat 760.27 30-day relationship rule).
If you need a letter in a hurry, plan accordingly.
What we do not do
A few clarifications about what is and is not part of the Veritas evaluation:
- We do not provide ongoing therapy. The ESA evaluation is a focused clinical conversation with a defined purpose. If you need ongoing mental-health care, we can suggest directions but we are not your treatment provider.
- We do not prescribe medication. The evaluation does not result in any prescription. Medication is a separate conversation with a different provider (or a different visit with a provider who handles both).
- We do not certify your animal. No such thing as ESA certification exists. Anyone offering it is selling air.
- We do not write letters for service-animal status. Service animals are governed by the ADA and do not require a clinician's letter for legal protection -- they require actual task training. We are not a service-animal training service.
- We do not write letters for air travel. ESA letters do not work for U.S. domestic air travel anymore (DOT rule change effective January 2021). Some international carriers may still accept ESA documentation; we do not represent that our letters will satisfy any specific airline's policy.
- We do not provide legal advice. The founder is a licensed attorney, but Veritas as a clinical practice does not represent patients in legal matters. If your situation needs legal advice, talk to a tenants' rights attorney.
Talk to a Veritas clinician
A licensed nurse practitioner in your state will evaluate whether ESA documentation is clinically appropriate in your situation. The fee is $99 and covers the evaluation itself, not a guaranteed outcome. If the clinician decides a letter is not the right fit, they will tell you why -- that honest answer is part of what you are paying for.
Educational content only. This post is not a clinical evaluation, not medical advice, and not a substitute for the professional judgment of a licensed clinician. Whether ESA documentation is issued in any individual case is determined solely by the licensed clinician's professional judgment at the time of your evaluation. Reading this article does not create a clinician-patient relationship.
Veritas Behavioral Group, LLC. Licensed clinicians available in AZ, CA, CO, DE, FL, ID, IL, KS, MA, NV, NM, NY, TX, UT, VT, WA, and WY.
This is not legal advice. Statutes and regulations change, courts interpret them, and your situation has facts this post does not know. For advice about your specific case, consult a licensed attorney in your state. Veritas's founder is a licensed attorney; this blog is not the practice of law and does not create an attorney-client relationship.