test Emotional & Mental Health Pre-Approval (These Questions MUST Be Answered by, or for, the Person Who Is In Need of the ESA/ PSD Approval Letters)1: Do you feel that you suffer from an emotional and/ or mental illness or disability?(Required)Examples: Insomnia, Depression, Stress, Anxiety, PTSD, Etc. Yes No 2: Have you been diagnosed by a licensed medical professional before for an emotional and/ or mental illness?(Required) Yes No 3: Does this process of applying for an Emotional Support Animal/ Psychiatric Service Dog Approval Letter make you nervous?(Required) Yes No 4: Have you been feeling sad and/ or depressed recently?(Required) Yes No 5: Have you had trouble falling asleep and/ or staying asleep recently?(Required) Yes No 6: Have you been feeling scared or paranoid recently?(Required) Yes No 7: Do you avoid situations that might make you feel uncomfortable?(Required) Yes No 8: When you don’t feel well, does your pet help you to feel better?(Required) Yes No 9: Does your pet(s) help you to feel safe and protected?(Required) Yes No 10: Does your pet(s) make you more active and/ or social?(Required) Yes No Consent(Required) I CONFIRM MY ANSWERS ARE TRUE & HONEST(Required) First Name(Required) Last Name(Required) Date of Birth(Required) MM slash DD slash YYYY Gender(Required)-Select-MaleFemalePhone(Required)Email(Required) Street Address(Required) Apartment/Unit # City(Required) State/Province(Required) Country(Required)-Select-AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsZip/Postal Code(Required) How Did You Hear About Permita Pet?(Required)-Select-Friend/FamilySocial MediaInternetPet ShelterOtherSelect All That Apply(Required) Dog Cat Other Select How Many Pet(s) You Would Like Coverage For:(Required)-Select-12345Have Your Pet(s) Been Trained?(Required)-Select-Yes, Professional TrainerYes, By MePet #1 Name(Required) Pet #1 Breed(Required) Pet #1 Weight(Required) Pet #2 Name(Required) Pet #2 Breed(Required) Pet #2 Weight(Required) Pet #3 Name(Required) Pet #3 Breed(Required) Pet #3 Weight(Required) Pet #4 Name(Required) Pet #4 Breed(Required) Pet #4 Weight(Required) Pet #5 Name(Required) Pet #5 Breed(Required) Pet #5 Weight(Required) Select Your Plan Choose the Housing and/ or Travel Plan that meets your needs! Our mission is to help you live and/ or travel with your animal(s) by your side, without you having to pay the airlines or your housing provider! Select Plan(Required) The COMBO Plan: Only $249 ESA/ PSD Housing Letter! ESA/ PSD Travel Letter! BIG Annual Discount To Renew! Housing ONLY Plan: $189 ESA/ PSD Housing Letter ONLY NO Annual Discount To Renew Travel ONLY Plan: $189 ESA/ PSD Travel Letter ONLY NO Annual Discount To Renew Rush Service(Required) NO Rush: 24 - 72 Hours Get Your Approval Letter(s) via Email Within 48- 72 Hours Of Your Submission 24 Hour Rush + $49.95 Get Your Approval Letter(s) via Email Within 24 Hours Of Your Submission SUPER Rush + 69.95 Get Your Approval Letter(s) via Email Within 12- 24 Hours Of Your Submission Total Coupon Credit Card(Required)Card Details Cardholder Name Consent Sign up for our newsletter, discounts, and tips. We respect your privacy and your inbox.Consent I have read and agree to the Terms and Conditions, Privacy Policy, and the following:*Check the box to confirm the name, date of birth, email address, gender and everything else is entered and spelled correctly. Any errors could cause complications and/ or slow the approval process, and if approved, there will be a $35 change or edit fee if anything needs to be changed.Please Click Here If You Run Into Any Issues or Difficulties With Submitting Your Order
