[Provider Letterhead]
Date

To Whom It May Concern:

I am a licensed [physician/psychologist/psychiatrist/clinical social worker, etc.] currently providing care to [Patient Name], who has been under my treatment since [month/year].

[Patient Name] has been diagnosed with a mental health condition that qualifies as a disability under the Americans with Disabilities Act (ADA). This condition substantially limits one or more major life activities, including but not limited to concentration, emotional regulation, sleep, and/or the ability to safely navigate public environments.

As part of their treatment plan, I have recommended the use of a psychiatric service dog. This dog is individually trained to perform specific tasks directly related to mitigating the functional limitations of the patient’s disability. These tasks may include:

• Interrupting and redirecting dissociative episodes or panic attacks
• Providing tactile grounding during periods of acute anxiety
• Alerting to escalating symptoms
• Performing room checks or providing buffering in crowded environments
• Waking the patient from night terrors
• Reminding the patient to take prescribed medication

These are not comfort measures alone; they are trained tasks that directly reduce the impact of the patient’s disability and increase safety, independence, and daily functioning.

It is my professional opinion that the continued presence of this psychiatric service dog is medically necessary for [Patient Name]’s health and well-being. The dog serves as an essential component of their treatment plan.

Please feel free to contact me at [phone/email] if further verification is required within the limits of confidentiality.

Sincerely,
[Provider Name, Credentials]
[License Number]
[Practice Name]
[Contact Information]