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Proof Service Dog Letter From Doctor PDF

Proof Service Dog Letter from Doctor - PDF

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Mariya Butchek
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© © All Rights Reserved
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1K views2 pages

Proof Service Dog Letter From Doctor PDF

Proof Service Dog Letter from Doctor - PDF

Uploaded by

Mariya Butchek
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Proof Service Dog Letter from Doctor

[Your Full Name]


[Your Title - e.g., M.D., Ph.D., Psy.D., LCSW, etc.]
[Your Medical License or Certification Number]
[Your Phone Number]
[Your Email Address]
[Your Physical Address: Street, City, State, ZIP Code]

[Today’s Date]

To Whom It May Concern,


I am writing this letter to verify that my patient, [Patient’s Full Name], whose
date of birth is [MM/DD/YYYY], is under my care and has been diagnosed
with [Specific Diagnosis or Condition], which is
a [type of disability, e.g., physical/mental/psychiatric/neurological] disability
as defined under the [Relevant Law or Act, e.g., Americans with Disabilities Act (ADA), Section
504 of the Rehabilitation Act, etc.]

Given the nature of [Patient’s Full Name]’s condition,


I am recommending that they utilize a service animal as part of their treatment and/or to help
with their disability. The service animal is necessary for the following task(s):

Task Specific Task or Work Related Aspect of Disability

[Task 01] [e.g., Guide Work] [e.g., Visual Impairment]

[Task 02] [e.g., Seizure Alert] [e.g., Epileptic Condition]

The service animal is specifically trained to perform these tasks, which are directly related to
[Patient’s Full Name]'s disability. The animal’s
presence is necessary for [Patient’s Full Name] to
[live independently/work/travel/etc.]

This letter serves as proof that [Patient’s Full Name] requires


a service animal as a reasonable accommodation due to their disability.

It is important to note the following points under the [Relevant Law or Act]:

1. The service animal must be under the control of its handler and must have been trained to
do work or perform tasks for the benefit of an individual with a disability.
2. Businesses and staff cannot ask about the person’s disability, require medical
documentation, require special identification for the service animal, or ask for the service

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animal to demonstrate its task.

The patient is responsible for the care and supervision of their service animal. This includes
hygiene, health, and control in public places.

This recommendation is made in accordance with [Relevant Law or Act] and


based on a thorough evaluation of [Patient’s Full Name]'s medical condition.

Please note that [Patient’s Full Name]'s condition and need for
a service animal are legitimate under the [Relevant Law or Act].

If you have any questions or need further clarification regarding this matter, please feel free to
contact me at [Your Phone Number] or
[Your Email Address].

Sincerely,
[Your Signature]
[Your Full Name Printed]
[Your Title]
[Your Medical License or Certification Number]
[Your Phone Number]
[Your Email Address]
[Your Physical Address: Street, City, State, ZIP Code]

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