Get Started - Loving Life Service Pets

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First Name

Last Name

How have you been feeling lately?

Over the past two weeks, how often have you had little interest or pleasure in doing things that you usually enjoy?

Over the past two weeks, how often have you felt sad or depressed?

Over the past two weeks, how often have you felt more angry or more irritated than usual?

Over the past two weeks, how often have you felt worried, anxious, or on edge?

Over the past two weeks, how often have you felt afraid or panicked?

Over the past two weeks, how often have you had irregular sleep? (Sleeping too much or too little)

Over the past two weeks, how often have you been acting impulsively? (Sudden use of drugs or alcohol, feeling like you're "on top of the world")

Over the past two weeks, how often have you avoided situations that make you nervous?

Over the past two weeks, how often have you heard things other people couldn't hear and seen things other people couldn't see?

Over the past two weeks, have you had suicidal thoughts?

Yes

I have read and agree that we may use your email address to contact you for transactional assistance – For example, if you do not properly complete the questionnaire or checkout process. The maker and provider of this form does not take responsibility for any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of any of this material. The actions of an emotional support animal is the full responsibility of its owner. By filling out this form and pressing next, you are providing your consent to Loving Life Service Pets to store and review your questionnaire for the purpose of connecting you with a licensed health professional so they can review your request. Loving Life Service Pets is not guaranteeing that a mental health professional will issue a recommendation for an ESA to you and will not influence the decision of the licensed mental health professional you are paired with. Your privacy is important to us and we take it seriously. If you have any questions or concerns, contact us at support@lovinglifeservicepets.com.

Free Qualification Assessment

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Your Pet's Info

How have you been feeling lately?