ESAUK - REGISTRATION 2021/2022
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Mental Health Org
GP - Doctor
Emotional Support Animal Registration
Animal's First Name:
Animal's Chip Number:
Upload Animal's Photo For ID Card:
(DO NOT SEND A CROPPED PHOTO - IT MUST BE IN FOCUS, BRIGHT LIGHT, CLOSE TO FACE)
select photo and upload with form - make sure its like a passport photo of your animal
+ Northern Ireland
Does Your Animal Have Any Training?:
If Trained What Level?
Upload Training Certificate
if your dog is professionally trained please upload the training certificate
HOUSE OR FLAT NUMBER
EXAMPLE - FLAT 1
NUMBER & STREET/ROAD NAME
EXAMPLE - 123 EARLS COURT ROAD
EXAMPLE - CHELSEA
EXAMPLE - LONDON
EXAMPLE - ESSEX
EXAMPLE - SW58SD
Animal's Instagram Address:
Name of Parent or Guardian if ESA Owner is under 16 years of age
Authorization of Parent or Guardian as the ESA Owner under 16
I Authorize this process for the person under 16 years of age under my care
Date of Birth:
Phone (cell preferred):
DUE TO LIMITED ACCESS TO MEDICAL PROFESSIONALS BECAUSE OF THE CORONAVIRUS A LETTER CAN BE SENT AS SOON AS YOU GET AN APPOINTMENT
Doctors/Mental Health Professional Information
I will get later after Coronavirus over
I have a Letter from a Doctor or Mentals Health Professional
Can You Produce the Letter if Required?
I will produce this letter after the Coronavirus
I can produce this letter if asked by ESA UK
Doctor's or Mentals Health Professional's Name
Address of Doctor or Mental Health Professional
Phone Number of Doctor or Mental Health Professional
Contact Email of Doctor or Mental Health Professional
if you do not have this type n/a
Date of Letter or Today's Date
Please review your information to make sure everything is as accurate as possible.
I hereby certify that information I have provided is accurate and correct to the best of my knowledge.
By inputting my signature, I confirm that to the best of knowledge, the information I have provided to ESAUK is accurate.
I also confirm that I understand my input information will be kept for ONLY 13 months & then deleted off the system except I agree to keep my name and email address after this period if I do not re-register.
I agree for the photo I have submitted to be used on Instagram with no name or location.
I understand that the behavior of animals cannot be guaranteed. I also understand that the behavior of domestic animals is sometimes unpredictable and that some domestic animals are capable of inflicting serious personal injury or death, as well as extensive property damage. Knowing the risks I agree to assume ALL those risks including, but not limited to; assuming the financial responsibility of any possible litigation arising from any incident in which I may be involved. I release, indemnify, and hold harmless ESAUK, ESAORGUK, and their Employees, Officers, Directors, Agents, or Contractors from any and all damages or personal injury. Any incident involving myself, the location, or those pets or actions of other participants and spectators will be my sole responsibility and I assume all financial liability and will also assume all and any financial costs associated with my actions.
I understand this is not to get my pet into places it is for my ongoing medical treatment.
NO REFUND as the documentation is printed and mailed to you by two outside companies & digital copies are also sent to you.
I also note that currently ESAs do not have the same rights as Service Animals & can be refused entry into any business.
ESAUK - ONE YEAR
THIS SECTION HELPS ADJUST THIS FORM FOR ANY ISSUES
IF PHONE USED
IF TABLET USED
POSTAL / MAILING ADDRESS - CAPITALS PLEASE
FOR THE ESA CARD, CERTIFICATE & CERTIFICATION LETTER
NAME / TO
EXAMPLE : JOHN DOE
FLAT HOUSE NUMBER
EXAMPLE : FLAT 1
NUMBER & STREET/ROAD NAME
EXAMPLE : 123 EARLS COURT ROAD
EXAMPLE : LONDON
EXAMPLE : ESSEX
EXAMPLE : SW67DF
IF YOU WANT AN ADDRESS OUTSIDE THE UK POSTAGE IS EXTRA