I am requesting to be assessed for the need of an Emotional Support Animal (ESA).

I understand that undergoing this assessment will not automatically qualify me for an ESA and I will be denied if I do not meet the criteria upon evaluation.

I understand to get an emotional support animal in Ohio I need to have a consultation with an Ohio-based licensed mental health professional. If the clinician determines you qualify for an emotional support animal they will write you an ESA letter, a document that you can present to your landlord in Ohio to receive accommodation for you emotional support animal, exempt from pet fees and restrictions.

I understand that all fees paid to Current Mind Counseling, LLC, are non-refundable despite the outcome of the evaluation. This means that if I am not found to meet criteria for an ESA, no funds will be returned. I am independently requesting this evaluation and hold no liability of the outcome to any persons other than myself. I agree to provide accurate and honest information during the entirety of the evaluation.

I understand this is a process and will require a minimum of two fifty minute follow-up appointments (not including an intake session).

I understand that an ESA letter is valid for six months from date of writing and I may be required to complete the evaluation again after the expiration to re-evaluate appropriateness of the need for an ESA. The initial evaluation may have no influence on the re-evaluation.

I understand that I am solely responsible for the training and behavior of the animal disclosed on my evaluation and that Jooyoung Kim, LPCC is not responsible for any behaviors, training or actions of the animal. Any actions or behaviors of the animal that violate my state or county laws are 100% my own liability as the owner of the animal both on public and private property.

I understand I may be suggested to receive a separate referral for behavioral evaluation of the animal and agree to comply with this recommendation.

I understand that Jooyoung Kim, LPCC may request records from prior mental health treatment or my veterinarian and agree to provide a release of information for these providers.

I understand that as part of my evaluation, I will be given recommendations for continued treatment of my qualifying diagnosis under the DSM-5TR. I agree to comply with these recommendations.

I understand the definition of an ESA in my state and understand this is different from a Service Animal, Therapy Animal, psychiatric service animal and I must classify my animal as an ESA and not anything other than an ESA.

I understand that unlike service animals, ESAs are not protected under the ADA. However, they are regulated by various federal, state, and local laws. I agree that I will be responsible for education of these laws.

Federal laws related to ESAs are:

1. Americans with Disabilities Act (ADA)

2. Fair Housing Act (FHA)

3. Air Carrier Access Act (ACAA)

4. Individuals with Disabilities Education Act (IDEA)

I understand that the rights of emotional support animal owners in Ohio are protected under federal Fair Housing laws. Although Ohio state law only recognizes service dogs as assistance animals, Ohio ESA owners are still fully protected under federal rules.

• The right to live in residences, including apartments and condos, that have a policy banning pets.

• Exemption from pet fees, including deposits, monthly fees, and application charges

• Protection against pet breed, weight, and size limitations

These rights are given under federal Fair Housing rules to ensure that individuals who need emotional support animals in Ohio are not discriminated against by landlords.