Here is a simple breakdown of the process of getting an ESA: Determine the ESA Benefits. If you suspect you may be suffering from a mental or emotional disability such as anxiety, depression, or panic attacks, it is a good idea to see a medical doctor and confirm whether or not there is a diagnosis to be made. Get a Referral. See a medical doctor and explain your symptoms. Open a dialogue to discuss treatment options for the disorder and talk with them about being referred to a therapist. A medical doctor cannot diagnose a mental disorder required to receive an ESA letter, so you will need to get a referral to an LMHP for that. Get a Diagnosis. After you have been given a referral to see an LMHP, you can discuss your symptoms to see if there is a diagnosis to be made. The diagnosis must be made by a licensed mental health professional. Be aware you may need to talk with them for 30 days before being able to receive an ESA letter. Check your state laws to see if there is a waiting period. Receive the ESA Letter. Once the emotional support animal letter is written it will be sent by mail within 1-3 business days. Going through a medical doctor is the traditional route, but it is not necessary. Online services like certapet.com require you to fill out a questionnaire before pairing you with a licensed therapist. This route is faster but may cost a bit more. Doing it this way effectively eliminates the second step in the process of talking with a medical doctor. Simply put, you will get your emotional support dog faster.