Psychiatric Animal Support Form PDF Details

In the realm of air travel, individuals with disabilities have unique needs, particularly those accompanied by psychiatric, therapeutic, or emotional support animals. Recognizing this essential aspect of travel for passengers with mental health-related disabilities, the Department of Transportation (DOT) has set forth guidelines to facilitate their journey. United Airlines, adhering to these guidelines, mandates that passengers traveling with such support animals obtain specific documentation. This documentation, known as the Psychiatric Animal Support form, confirms that the accompanying animal is crucial for the passenger's mental health or treatment, as asserted by a licensed medical or mental health professional. The process ensures the animal is not only necessary for the passenger's mental wellbeing but also trained to behave appropriately in public settings, safeguarding the comfort and safety of all travelers. The form, valid for a year from the date of signing by a qualified professional, includes critical details such as the professional's license information, the type of animal, and its physical characteristics. It embodies a mechanism designed to integrate the therapeutic benefits of emotional support animals within the regulated confines of air travel, while addressing the logistical and safety concerns inherent in bringing animals into the cabin — ensuring a balance between accommodating mental health needs and maintaining an orderly travel environment. Regulations also stipulate that the support animal be properly harnessed throughout the flight, with provisions for small animals to remain in the passenger's lap or in a carrier under the seat, adhering to USDA guidelines. This form, alongside associated instructions, outlines the responsibilities of the medical or mental health professional, the passenger, and airline staff, including the United Airlines Accessibility Desk and airport agents, in verifying and facilitating the animal's carriage, thus ensuring a streamlined process for passengers requiring such support on their travels.

QuestionAnswer
Form NamePsychiatric Animal Support Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesanimal support letter, fillable certificates for emotional support animal, therapeutic emotional authorization printable, psychiatric therapeutic united

Form Preview Example

Psychiatric/Therapeutic/Emotional Support Animal Authorization

General information:

Pursuant to the Department of Transportation (DOT) guidance for the carriage of service animals, United requires a passenger with a qualified disability traveling with a psychiatric/therapeutic/emotional support type animal to obtain documentation from their medical/mental health professional.

This form is valid for one year from the date the licensed medical or mental health professional treating the person has signed this form.

Other documentation may be required for travel entering or exiting an international location.

Service animals must be properly harnessed for the duration of the flight. Small animals may remain in the passenger’s lap during the flight. If a carrier will be used, it must meet the USDA guidelines and fit under the aircraft seat.

Instructions:

 

Medical/Mental Health

 

Professional:

Please complete this form or provide the passenger with a written statement containing the information on

 

this form on your practice letterhead.

Passenger:

Send a copy of the form or written statement to the United Airlines Accessibility Desk by fax (872-825-

 

0208) or email (uaaeromed@united.com) 48 hours prior to travel for documentation verification (by

 

contacting your health care professional). Please retain the original form or your medical/mental health

 

professional statement in your possession while traveling and be prepared to present it to airline

 

representatives.

Accessibility Desk:

Verify documentation. Complete SSR in the PNR with ESAN APPROVED or NOT APPROVED and your

 

name.

Airport Agent:

Verify the passenger’s documentation and SSR information in the PNR. Verify the animal meets the

 

requirements (i.e., behavior) to travel in the passenger cabin free of charge.

Note: With respect to an animal used to assist a qualified individual with a disability, the animal must be trained to behave appropriately in a public setting. Animals found not to have been trained to behave will only be accepted in accordance with United’s current pet policies or may be denied boarding.

Initial

 

Must be completed by Medical/Mental Health Professional

 

 

 

 

 

 

I certify that the passenger has a mental health-related disability listed in the Diagnostic and Statistical Manual of Mental

 

 

 

 

 

 

Disorders (DSM-5).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Having the animal accompany the passenger is necessary to the passenger’s mental health or treatment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am a licensed medical/mental health professional treating the passenger’s mental or emotional disability.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The passenger is under my professional care.

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical/Mental health professional’s license information:

 

 

 

 

 

 

Date and type of the license:

 

 

 

 

 

 

 

 

License Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State or other jurisdiction in which license was issued:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Name (print):

 

 

 

 

 

 

Signature and Date:

 

 

 

 

 

 

Business Phone Contact:

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger/Patient Name (print):

 

 

 

 

 

 

 

 

 

 

 

 

 

Animal Type, Breed and Weight:

 

 

 

 

 

 

 

 

 

 

 

 

 

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