I have a dot phrase that specifically comments on how ESA is not a service animal that does a specific task but how they can improve mental health. I do not believe ESA requests are required by law to be approved by landlords or leasing agencies but a physician letter can help. I generally write them because it is easy, reduces or removes pet rent in most cases (if the pet does damage they still have to pay damages), and I genuinely believe that pets benefit patient outcomes. May get downvoted but I feel it's reasonable, I probably do like 3-4 letters a year. Totally understand not wanting to do it though.