Emotional Support Animal (ESA) Policies

Family Care recognizes that animals can be great friends and companions for humans. Pets can become part of your family and develop loving, long-lasting bonds that improve the lives of their owners. For patients with mental health issues, like depression or anxiety, the impact of an Emotional Support Animal (ESA) can be life-changing.

We support these relationships and want to help our patients overcome the administrative obstacles that many housing providers have put in place regarding pets and other animals. To make the process simple and consistent for all patients, we have created an outline for patients to follow to ensure they can obtain the necessary documentation.

Step 1: Appointment at Family Care

To be considered for an ESA Waiver, you will first need to schedule an appointment at Family Care to discuss the reasons that you believe would qualify you for an Emotional Support Animal. You will receive a brief mental health screening and your provider may choose to make the recommendation for additional counseling. You may choose your own mental health provider, or we can suggest one for you. This visit would be a normal medical appointment, with your usual copay or deductible amounts owed for the visit.

Step 2: Referral to Mental Health

After your visit to confirm the reasons for a potential ESA waiver, we will send a referral for you to visit the agreed upon mental health provider. The State of North Carolina requires Emotional Support Animal waivers to be signed by a Licensed Mental Health Counselor (LMHC), but some housing providers extend this requirement to also allow primary care providers to sign these letters. You will want to be clear with your housing provider about their requirements.

Step 3: Visit with Mental Health Provider

You will schedule an appointment with a mental health provider. During this visit, your mental health provider may choose to write and sign your ESA Waiver request. To be sure this provider can complete your request, you may want to ask during scheduling if this is a service they can provide.

Step 4: Records Request

This step is usually unnecessary, but may be required if your LMHC does not wish to sign a ESA Waiver for any reason. If they choose not to sign a waiver, Family Care can request your visit notes from your mental health provider and attempt to complete an ESA Waiver on your behalf based on these notes. If we get to this point and Family Care is able to complete your ESA Waiver, you will be charged a $10 form fee.


There are some exceptions to the rules above, so read below to see if they might apply to you:

  • If you already have an existing relationship with a psychiatrist or LMHC, you may skip Steps 1 & 2 and proceed to Step 3.
  • If you do not have a mental health diagnosis that qualifies for an ESA Exemption, you will not receive one.

If you have any questions, please ask!