Who can write an ESA letter?

In this article▾

1. What this guide covers
2. What is an ESA letter?
3. Who can write an ESA letter?
4. Can a therapist write an ESA letter?
5. Can a psychologist write an ESA letter?
6. Can a psychiatrist write an ESA letter?
7. Can a social worker write an ESA letter?
8. Can a counselor write an ESA letter?
9. Can a primary care doctor write an ESA letter?
10. Can a nurse practitioner write an ESA letter?
11. Who cannot write an ESA letter?
12. Does the clinician have to be licensed in the patient's state?
13. Does telehealth change who can write an ESA letter?
14. What if the clinician and patient live in different states?
15. Can an associate write an ESA letter?
16. Does the clinician need to have treated the patient for a certain amount of time?
17. Does a clinician need to diagnose the patient before writing an ESA letter?
18. What should an ESA letter include?
19. What should clinicians document in the clinical record?
20. What if a patient asks for an ESA letter but the clinician does not think one is appropriate?
21. What about online ESA letter services?
22. How should telehealth practices handle ESA letter requests?
23. Common mistakes clinicians make with ESA letters
24. How AI can help clinicians with ESA letter workflows
25. ESA letter eligibility checklist for clinicians
26. Frequently asked questions
27. The clinician's responsibility comes before the template
28. Sources

Who can write an ESA letter? Usually, a licensed healthcare or behavioral health professional who is legally permitted to practice in the patient's jurisdiction and whose scope of practice supports the clinical assessment being documented.

That answer is more useful to clinicians than simply saying "any therapist" or "any doctor."

An ESA letter is clinical documentation. The question is not only whether a professional holds a healthcare license. It is whether that specific professional can evaluate the patient's condition, determine whether an emotional support animal is clinically appropriate, and document that opinion within the laws and professional rules that apply to the encounter.

This becomes particularly important when the encounter happens through telehealth, when the clinician and patient are in different states, or when the clinician is an associate, intern, trainee, or registrant working under supervision.

This guide breaks down who can write an ESA letter, who generally cannot, and the questions clinicians should answer before putting their name on one.

What this guide covers

• Which licenses and credentials actually support ESA documentation, profession by profession
• What telehealth does to the question when the patient is in another state
• Where associates, interns and registrants sit, and why the answer is state-specific
• An eligibility checklist to run before you sign

What is an ESA letter?

An emotional support animal (ESA) letter is documentation from a qualified healthcare or behavioral health professional stating that a patient has a disability-related need for an emotional support animal.

For housing, the relevant federal framework is the Fair Housing Act and its reasonable-accommodation requirement, which has no training requirement in it. HUD's own enforcement posture narrowed in 2026, when it withdrew its 2013 and 2020 assistance-animal guidance and began pursuing reasonable-cause findings only where the animal is individually trained. The statute, private lawsuits under it, and state fair-housing laws were not changed. We went through that in what HUD's ESA guidance rescission means for clinicians.

Sources: 42 U.S.C. § 3604(f)(3)(B) · 24 C.F.R. § 100.204 · HUD FHEO enforcement memorandum, May 22, 2026 · 91 FR 17291 (April 6, 2026)

An ESA is not the same thing as a service animal under the Americans with Disabilities Act, which is a dog individually trained to do work or perform tasks for a person with a disability.

That distinction matters because clinicians sometimes receive requests from patients who use "ESA," "service animal," "therapy animal," and "support animal" interchangeably.

They are not interchangeable legal categories.

An ESA letter also does not turn an animal into a universally recognized service animal, does not create general public-access rights, and does not function as a certification or registration document.

For clinicians, the letter should therefore stay focused on the clinical question: Is there a disability-related need for this animal, and is that conclusion supported by the clinician's evaluation and scope of practice? Our clinician's guide to ESA letters works through that question at length; this post is about the half of it that is a licensure problem rather than a clinical one.

Who can write an ESA letter?

There is no single federal list that gives every state the same answer.

In practice, ESA letters are commonly written by licensed behavioral health professionals such as:

• Psychologists
• Psychiatrists
• Licensed clinical social workers
• Licensed professional counselors
• Licensed mental health counselors
• Licensed marriage and family therapists
• Other independently licensed behavioral health professionals whose state scope of practice supports the relevant evaluation

Physicians may also be able to provide documentation when the patient's condition and the physician's scope, training, and clinical relationship support the assessment.

The important qualification is licensed and legally authorized to practice for the patient in the relevant jurisdiction.

A professional title by itself does not answer the question.

For example, "therapist" can describe people with very different licenses, registrations, training pathways, and scopes of practice depending on the state.

The same is true for "counselor," "social worker," and "psychologist."

Before writing an ESA letter, clinicians should therefore ask:

1. What license or credential do I hold?
2. Is it active?
3. What does my state allow someone with this credential to diagnose, assess, and document?
4. Where is my patient located?
5. Am I legally permitted to provide care to that patient in that jurisdiction?
6. Does the state impose additional requirements on ESA documentation?
7. Does my professional liability coverage permit this type of documentation?

Those questions are more reliable than a generic "ESA provider" checklist.

Can a therapist write an ESA letter?

Yes, a therapist may be able to write an ESA letter if the therapist holds a license or other authorization that permits the relevant clinical practice and the therapist is legally practicing in the patient's jurisdiction.

This is why "Can my therapist write an ESA letter?" cannot be answered simply by looking at the word therapist.

Consider two clinicians:

Clinician A: An independently licensed clinical social worker who is treating a patient for an ongoing behavioral health condition.

Clinician B: A graduate student completing supervised clinical hours and using the title "therapist" at a training clinic.

Those clinicians may have very different authority to independently issue clinical documentation.

The second clinician should not assume that because they participate in therapy sessions, they can independently sign an ESA letter.

The applicable state rules and supervision arrangement need to be checked first.

Can a psychologist write an ESA letter?

An independently licensed psychologist may write an ESA letter when the evaluation falls within the psychologist's scope of practice and the psychologist is authorized to practice where the patient is located.

Psychologists should distinguish between:

• Evaluating a patient's condition
• Determining whether an ESA is clinically appropriate
• Documenting that determination
• Making a legal determination about housing rights

The clinician is responsible for the clinical opinion. The clinician does not need to determine whether a landlord has complied with every aspect of fair-housing law.

A useful letter therefore avoids making broad legal promises such as:

"Your landlord is legally required to accept this animal."

Instead, it documents the clinical findings and disability-related need that support the patient's accommodation request.

Can a psychiatrist write an ESA letter?

Yes, a psychiatrist may be able to provide ESA documentation when doing so falls within the psychiatrist's clinical practice and applicable state requirements.

Psychiatrists may be particularly familiar with evaluating psychiatric conditions, treatment history, functional impairment, and treatment response.

But being a psychiatrist does not automatically mean that every ESA request should be approved.

The same clinical standard should apply:

Is there a clinically supported disability-related need for the animal?

A patient's request for an ESA letter is not itself the clinical conclusion.

Can a social worker write an ESA letter?

A licensed clinical social worker may be able to write an ESA letter when the state's scope of practice permits the relevant assessment and documentation.

This is one area where clinicians should be careful about confusing education or job title with independent licensure.

"Social worker" may refer to professionals at different stages of training and licensure.

An LCSW, an LMSW, a social work associate, and a social work student may not have the same authority to independently diagnose, treat, or issue clinical documentation.

The specific state license matters.

Can a counselor write an ESA letter?

A licensed counselor may be able to write an ESA letter if the counselor's credential and state scope of practice support the underlying assessment.

This can include titles such as:

• LPC
• LPCC
• LMHC
• Licensed professional counselor
• Licensed mental health counselor

But these titles are not interchangeable nationwide.

A clinician practicing across state lines should verify the patient's state's requirements rather than assuming that a license recognized in the clinician's home state provides authority everywhere.

Can a primary care doctor write an ESA letter?

Possibly.

There is an important difference between being medically licensed and having an appropriate clinical basis for the particular opinion being documented.

A physician who knows a patient's mental health history and is appropriately evaluating the relevant condition may be able to document a disability-related need for an emotional support animal.

However, a physician should not sign an ESA letter merely because the patient asks for one.

If the physician does not have sufficient information to evaluate the patient's behavioral health condition or the role of the animal, referral to an appropriate behavioral health professional may be more appropriate.

The same principle applies to other medical professionals.

Can a nurse practitioner write an ESA letter?

This depends on state law, credential, scope of practice, and the nature of the assessment.

A psychiatric mental health nurse practitioner may have a different scope from a nurse practitioner working in another specialty.

The relevant question is not simply:

"Is an NP a healthcare professional?"

It is:

"Does this NP have the authority and clinical basis to perform and document this particular assessment in this jurisdiction?"

That distinction is especially important for clinicians working across state lines.

Who cannot write an ESA letter?

A person should not assume that they can issue an ESA letter simply because they work in healthcare, counseling, wellness, or animal care.

Examples that generally should not be treated as substitutes for a qualified clinical evaluation include:

• Veterinarians
• Life coaches
• Wellness coaches
• Unlicensed counselors
• Unlicensed "therapists"
• Pet trainers
• ESA registration websites
• ESA certificate or ID-card services
• Friends or family members
• A clinician signing a letter without actually evaluating the patient

A veterinarian can provide valuable information about an animal's health and behavior. That does not make the veterinarian the appropriate professional to determine a patient's disability-related need for an emotional support animal.

Likewise, an ESA website may facilitate an evaluation, but the website itself is not the clinician.

The actual clinical professional and their license matter.

Does the clinician have to be licensed in the patient's state?

For telehealth, this is one of the most important questions.

In general, a clinician providing telebehavioral health services needs to comply with the laws of the state where the patient is located.

Federal telehealth guidance puts it precisely: health professionals must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located. Those are two separate tests, and a clinician who moves, or whose patient travels, can satisfy one and fail the other.

Sources: Telehealth.HHS.gov: licensure for behavioral health · licensing across state lines

That means a clinician cannot assume:

"I am licensed in State A, so I can write an ESA letter for my patient who is currently in State B."

State B may require a full license, temporary practice authority, reciprocity, a telehealth registration, compact participation, or another form of permission. HHS lists those five pathways and notes that they vary state by state.

The exact pathway varies by state.

Does telehealth change who can write an ESA letter?

Telehealth changes how the clinical encounter occurs, but it does not eliminate professional licensure requirements.

A clinician conducting an ESA evaluation by video should treat the patient's location as a jurisdictional issue, not merely a scheduling detail.

Before the session, document:

• Patient's physical location
• Clinician's physical location
• Professional license
• Jurisdiction of licensure
• Any applicable interstate authorization
• Telehealth consent requirements
• Relevant state-specific rules
• Whether the clinical encounter is appropriate for telehealth

For example, a clinician licensed in Colorado has a patient who normally lives in Colorado but joins a session while temporarily staying in Arizona.

The clinician should not automatically treat the encounter as a Colorado encounter.

The patient's location at the time of the telehealth service can affect which state's rules apply.

This is one reason a telehealth platform should make patient location easy to confirm and document, and one reason to capture it at intake rather than at the end of the session. HHS makes the same point: verify patient location and obtain consent before the appointment. Digital patient intake forms are the cheapest place to put that field.

What if the clinician and patient live in different states?

Start with the patient's location during the encounter.

Then determine whether the clinician is authorized to practice there.

Possible mechanisms can include:

• A full state license
• Temporary practice authority
• Reciprocity
• A state telehealth registration
• An interstate licensure compact
• Another state-specific authorization

The existence of an interstate compact does not mean every profession can practice everywhere through a single national license.

For example, PSYPACT authorizes eligible psychologists to practice telepsychology across member states, but membership, eligibility and the authority it grants still have to be verified. Compacts also exist for physicians (IMLC) and nurses (NLC), and there is no compact at all for several behavioral health professions.

The safest operational approach is to verify the jurisdiction before the clinical encounter rather than after the ESA letter has been issued.

Can an associate write an ESA letter?

This is where generic online advice becomes particularly unreliable.

An associate, intern, resident, trainee, or registrant may be providing legitimate clinical services under supervision while still lacking independent authority to practice.

Whether that person can independently sign an ESA letter depends on the state's credentialing and supervision rules.

The key distinction is:

Participating in a clinical evaluation does not necessarily mean having independent authority to issue the resulting clinical documentation.

Before an associate signs, the practice should verify:

• The exact credential held
• Whether the credential permits independent or supervised practice
• The supervisor's role
• Whether the supervisor must review or co-sign documentation
• Whether the state permits the associate to make the relevant clinical determination
• Whether the letter can be issued under the associate's name
• Whether the practice's policies allow it

If the state rules are unclear, the practice should seek guidance from the relevant licensing board or qualified legal counsel.

What about registered associates?

"Registered associate" is not a universal credential.

It has a specific meaning in some state licensing systems and may describe professionals accumulating supervised experience toward independent licensure.

California is a useful example.

California's AB 468 sets specific requirements for covered health care practitioners providing ESA documentation for emotional support dogs. Among them, the practitioner must hold a valid, active license, must be licensed in the jurisdiction where the documentation is provided, and must have had a client-provider relationship of at least 30 days, unless the individual is verified to be homeless.

Sources: California Health and Safety Code § 122318 · Board of Psychology summary

The statute therefore illustrates why a national article cannot simply say "associates can write ESA letters" or "associates cannot write ESA letters."

The answer depends on the exact credential, state law, supervision structure, and type of documentation involved.

For California clinicians, check the statute directly before issuing an ESA letter, and note that both licensing board summaries predate the 2023 amendment. Our guide to AB 468 has the current requirements in order.

Does the clinician need to have treated the patient for a certain amount of time?

There is no single nationwide treatment-duration requirement that applies to every clinician and every ESA letter.

However, individual states can impose additional requirements.

California, for example, has a 30-day client-provider relationship requirement for practitioners covered by AB 468 when providing documentation for emotional support dogs, with a statutory exception for individuals verified to be homeless.

Other states may use different requirements or no equivalent statutory waiting period.

Clinicians should therefore avoid blanket statements such as:

"You must treat a patient for 30 days before writing an ESA letter."

That is not a universal federal rule.

Instead, ask:

Does the jurisdiction where I practice impose a minimum relationship, evaluation, or documentation requirement?

Does a clinician need to diagnose the patient before writing an ESA letter?

The clinician should have a sufficient clinical basis for the opinion being documented.

An ESA letter should not be treated as a form that can be completed simply because a patient requests housing accommodation.

The evaluation should establish the relevant clinical facts, including the patient's condition, functional impact, and the relationship between the requested animal and the patient's disability-related needs.

Clinicians should also distinguish between documenting a clinical condition and disclosing unnecessary protected health information.

A housing provider generally does not need the patient's complete psychotherapy history.

The letter should contain the information necessary to support the accommodation request while respecting confidentiality.

What should an ESA letter include?

There is no federal ESA letter template that every clinician must use. Our ESA letter template is a starting point you can copy, with notes on what each section is doing.

A practical letter generally identifies:

• The clinician
• Professional credentials and license
• Contact information
• Patient
• Date
• Clinical relationship, where relevant
• Relevant clinical findings
• Disability-related need for the assistance animal
• Clinical rationale
• Signature

The letter should be accurate, individualized, and consistent with the patient's clinical record.

It should not contain claims that the clinician cannot support.

It should also avoid turning a clinical document into a legal brief. The clinician's guide to ESA letters covers the clinical reasoning behind each of those elements.

What should clinicians document in the clinical record?

The ESA letter is not the assessment itself.

The underlying record should support the opinion contained in the letter.

Depending on the clinical situation, documentation may address:

Clinical presentation

What symptoms, condition, or functional difficulties are relevant?

Functional impact

How does the condition affect the patient's daily functioning?

Current treatment

What treatment is being provided, and how does the request relate to the patient's existing care?

Animal-related clinical rationale

Why does the clinician believe the animal provides disability-related support?

Clinical judgment

What information did the clinician consider in reaching the conclusion?

Patient request

What accommodation is the patient requesting, and for what purpose?

The letter can then summarize the relevant conclusion without reproducing the entire clinical record.

What if a patient asks for an ESA letter but the clinician does not think one is appropriate?

The clinician does not have to issue an ESA letter simply because a patient asks for one.

The request should be handled as a clinical assessment.

If the clinician cannot establish a disability-related need, the appropriate response is not to manufacture a justification.

The clinician can explain that documentation can only be provided when supported by their professional evaluation.

Depending on the circumstances, the clinician may:

• Continue assessment
• Ask for additional clinical information
• Discuss other treatment options
• Refer the patient to an appropriate professional
• Decline to provide the requested documentation

A patient requesting a particular document does not determine the clinical conclusion.

What about online ESA letter services?

An online platform does not itself make an ESA letter valid or invalid.

The important question is whether an appropriately qualified clinician actually evaluates the patient and issues the documentation within the clinician's legal and professional scope.

Clinicians should be cautious about workflows built around:

• Instant approvals
• No clinical evaluation
• Guaranteed letters
• Automatic diagnoses
• Pre-filled documentation that does not reflect the patient's circumstances
• Clinicians signing letters for patients they have not evaluated
• Templates that make unsupported legal claims

Technology can support the clinical workflow.

It should not replace clinical judgment.

How should telehealth practices handle ESA letter requests?

If your practice provides behavioral healthcare through telehealth, build ESA requests into your existing documentation workflow rather than treating them as an administrative afterthought.

A practical workflow looks like this:

1. Confirm patient location

Record where the patient is physically located for the encounter.

2. Verify clinician authorization

Confirm that the clinician is licensed or otherwise legally authorized to practice in that jurisdiction.

3. Review state-specific rules

Check whether the jurisdiction has additional ESA documentation requirements.

4. Conduct the clinical assessment

Determine whether the patient's condition and functional needs support the request.

5. Document the reasoning

Make sure the clinical record supports the conclusion.

6. Draft the letter

Use a consistent template, but customize it to the patient.

7. Review before signing

Check license information, dates, patient identity, clinical language, and unnecessary disclosures.

8. Store the final document

Keep the signed letter and supporting documentation according to the practice's record-retention and privacy policies.

This is also where a HIPAA-conscious telehealth workflow matters. Your platform should make it possible to document patient location, consent, clinical encounters and records without a separate administrative process for every type of documentation request. If you bill the telehealth sessions behind those letters, the same location field drives your place of service code, so it is worth capturing once and reusing.

Common mistakes clinicians make with ESA letters

Mistake 1: Treating "therapist" as a license

Always identify the actual license or credential.

Mistake 2: Assuming your home-state license covers telehealth everywhere

The patient's location can trigger another state's licensing requirements.

Mistake 3: Assuming an associate has the same authority as a fully licensed clinician

Supervised practice and independent practice are not necessarily equivalent.

Mistake 4: Using a generic letter without a clinical evaluation

A template is a documentation tool, not a substitute for assessment. Our ESA letter template is written on that assumption: assess first, then fill it in.

Mistake 5: Promising housing approval

The clinician can document the clinical basis for an accommodation. The clinician should not guarantee how a housing provider will respond.

Mistake 6: Calling an ESA a service animal

An emotional support animal does not automatically receive the same protections as an ADA service animal.

Mistake 7: Over-disclosing the patient's diagnosis

Include clinically necessary information and protect the patient's privacy.

Mistake 8: Forgetting state-specific requirements

Federal housing rules do not eliminate state professional-practice requirements.

How AI can help clinicians with ESA letter workflows

AI can be useful for the administrative parts of ESA documentation, but it should not decide whether a patient needs an emotional support animal.

The most useful applications are documentation support, consistency checks, and workflow organization.

For example, AI can help a clinician turn an existing assessment into a structured draft by organizing information already documented in the chart. It can identify whether the draft contains the clinician's credentials, patient identification, date, clinical rationale, and other required fields.

AI can also help identify obvious inconsistencies before a letter is signed.

For a telehealth practice, the workflow can be particularly useful:

Patient location → licensure check → clinical assessment → documentation → letter draft → clinician review → signature.

An AI-enabled documentation workflow can surface missing fields such as the patient's location or the clinician's license information, and it can help separate what belongs in the clinical record from what belongs in the accommodation letter.

That is the part worth automating, because it is the part that is identical for every patient. Supanote turns a recorded, dictated or uploaded session into a structured note in a format you define, and you edit in plain English and sign off before anything leaves your hands. If patient location, relationship start date and license details live in the note in the same place every time, the licensure question answers itself on the way past instead of becoming a separate check someone has to remember. For practices where the administrative weight sits on the billing side instead, Supa builds the revenue cycle for outpatient mental health practices.

What none of it does is decide. A model cannot tell you whether your license reaches the state your patient is sitting in, and it cannot read a supervision agreement and tell you whether an associate may sign. The final clinical and licensure judgment stays with the licensed professional.

AI should not:

• Diagnose a patient solely to support an ESA request
• Decide that an ESA is clinically necessary
• Select a diagnosis because it makes a letter more likely to be accepted
• Determine whether a clinician is legally licensed in a state without verification
• Sign an ESA letter
• Guarantee that a landlord will accept documentation

The clinician should review every generated document against the actual clinical record before signing.

ESA letter eligibility checklist for clinicians

Before signing an ESA letter, ask:

Clinician

• Is my license active?
• Am I authorized to practice in the patient's location?
• Is this assessment within my scope of practice?
• Does my liability coverage permit this documentation?

Patient

• Have I actually evaluated this patient?
• Is there sufficient clinical information to support my opinion?
• Is the disability-related need documented?
• Is the request consistent with the treatment relationship?

Jurisdiction

• What state is the patient physically located in?
• Are there state-specific ESA requirements?
• Does the patient's credential or my credential create additional restrictions?
• If telehealth was used, did I comply with the applicable telehealth rules?

Letter

• Are my credentials and license information accurate?
• Is the letter individualized?
• Does the clinical record support it?
• Does it avoid unnecessary protected health information?
• Does it avoid promising a legal outcome?
• Have I personally reviewed and signed it?

Frequently asked questions

Can any therapist write an ESA letter?

No. "Therapist" is not a universal license category. The clinician needs an appropriate license or authorization, must be legally permitted to practice where the patient is located, and must act within their scope.

Can a psychologist write an ESA letter?

An independently licensed psychologist may be able to write one when the assessment is within their scope and applicable state requirements are satisfied.

Can a psychiatrist write an ESA letter?

Yes, a psychiatrist may be able to provide ESA documentation when the clinical assessment and applicable state rules support it.

Can an LCSW write an ESA letter?

An LCSW may be able to write one when the state's scope of practice permits the relevant assessment and documentation.

Can an LPC write an ESA letter?

An LPC may be able to do so, but the exact scope and requirements depend on state law.

Can a primary care physician write an ESA letter?

Possibly. The physician needs an appropriate clinical basis for the opinion and must comply with applicable state scope-of-practice requirements.

Can a nurse practitioner write an ESA letter?

Possibly. The answer depends on the NP's credential, scope of practice, state law, and the nature of the clinical assessment.

Can a social work associate write an ESA letter?

Not automatically. Associates typically practice under state-specific supervision rules, and independent authority to issue clinical documentation varies by jurisdiction.

Can an intern write an ESA letter?

Do not assume so. The intern's credential, supervision structure, state law, and practice setting determine what documentation they may independently issue.

Can an associate sign an ESA letter?

It depends on the state's rules and the associate's specific credential. Supervised clinical practice does not automatically equal independent authority.

Can a therapist write an ESA letter through telehealth?

Potentially. The therapist must comply with the telehealth and professional-licensure rules applicable to the patient's location.

Does the clinician have to live in the same state as the patient?

Not necessarily. What matters is whether the clinician is legally authorized to practice in the patient's jurisdiction. Interstate compacts and other authorization pathways can affect the answer.

Does an ESA letter give an animal public-access rights?

No. ESA status should not be confused with ADA service-animal status.

Can a veterinarian write an ESA letter?

A veterinarian can document an animal's health or behavior, but that does not substitute for the patient's disability-related clinical assessment.

Does every state require a 30-day relationship before an ESA letter?

No. A 30-day relationship requirement is not a universal federal rule. Some states have specific requirements. California, for example, has a 30-day client-provider relationship requirement under AB 468 for covered practitioners providing documentation for emotional support dogs.

The clinician's responsibility comes before the template

The question "Who can write an ESA letter?" sounds like a credentialing question.

For clinicians, it is really four questions:

1. Are you licensed?
2. Are you authorized to practice where the patient is located?
3. Is the assessment within your scope?
4. Does your clinical record support the opinion you're documenting?

If the answer to all four is yes, an ESA letter can be part of a legitimate clinical documentation workflow.

If any answer is unclear, pause before signing.

State rules, telehealth requirements, and professional scopes can differ significantly. When in doubt, verify the rule with the relevant licensing board or qualified legal counsel rather than relying on a generic ESA template or an online checklist.

Once you have established that you can write the letter, the clinician's guide to ESA letters covers what goes in it, the ESA letter template gives you the structure, and California AB 468 covers the one state with a statute aimed squarely at this document.

Sources

1. California Board of Psychology. Law change regarding emotional support animals: What Board of Psychology licensees need to know. psychology.ca.gov

2. California Board of Behavioral Sciences. (2022). Law change regarding emotional support animals: What BBS licensees need to know. bbs.ca.gov

3. California Civil Rights Department. (2026, July 20). Legal alert: Compliance with state fair housing laws with regard to emotional support animals (CRD 2026-01). calcivilrights.ca.gov

4. California Civil Rights Department. (2026, August). Emotional support animals and fair housing law. calcivilrights.ca.gov

5. California Health and Safety Code § 122318 (practitioner requirements for emotional support dog documentation). leginfo.legislature.ca.gov

6. California Legislature. AB 468: Emotional support animals (Stats. 2021, ch. 168). leginfo.legislature.ca.gov

7. Fair Housing Act, 42 U.S.C. § 3604(f)(3)(B). law.cornell.edu

8. Reasonable accommodations, 24 C.F.R. § 100.204. law.cornell.edu

9. U.S. Department of Health and Human Services. Licensure for behavioral health. Telehealth.HHS.gov. telehealth.hhs.gov

10. U.S. Department of Health and Human Services. Licensing across state lines. Telehealth.HHS.gov. telehealth.hhs.gov

11. U.S. Department of Health and Human Services. Licensure compacts. Telehealth.HHS.gov. telehealth.hhs.gov

12. U.S. Department of Health and Human Services. Minimum necessary requirement. hhs.gov

13. U.S. Department of Housing and Urban Development. (2026, April 6). Withdrawal of assistance animal guidance documents, 91 FR 17291 (Docket FR-6571-N-01). govinfo.gov

14. U.S. Department of Housing and Urban Development, Office of Fair Housing and Equal Opportunity. (2026, May 22). Enforcement guidance: Assessing requests for the use of an animal as a reasonable accommodation under the Fair Housing Act [Memorandum]. hud.gov

15. U.S. Department of Justice. ADA requirements: Service animals. ada.gov

16. U.S. Department of Justice. Service animals. ada.gov

Compliance note: This guide is educational content, not legal advice. Licensure, scope of practice and telehealth requirements differ by state and change over time. Verify the current rule with the relevant licensing board or qualified legal counsel before issuing ESA documentation. Every source above was opened and checked on September 25, 2026.