Page 1 of Emotional Support Animal (ESA) Disability Verification Form - Google Docs 2026

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The document is an Emotional Support Animal (ESA) Disability Verification Form from Pepperdine University's Office of Student Accessibility. It is designed for medical or mental health professionals to provide information regarding a student's disability and the necessity of an ESA in on-campus housing. The form includes sections for the provider's details, the proposed ESA's information, and questions about the student's disability, treatment, and the importance of the ESA for their well-being.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the physician or provider's name and title in the designated field. This is crucial for verifying the authenticity of the form.
Next, provide the contact information including phone number and fax number. Ensure these details are accurate for any follow-up communication.
Fill in the organization name and address, along with an email address. This information helps streamline communication between the Office of Student Accessibility and your provider.
Review all entered information for accuracy before saving or submitting. Our platform allows you to easily edit any mistakes.

Start using our platform today to complete your ESA Disability Verification Form effortlessly!

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (53 Votes)
2019	4.6 Satisfied (39 Votes)

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