ESA Letter Online Application


Emotional Support Animal Letter Online Application
To apply for your ESA letter please complete this form.
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Patient Information

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We will email your invoice and a digital copy of your ESA letter.

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ESA Pet Information

PHYSICIAN-PATIENT ARBITRATION AGREEMENT

AGREEMENT TO ARBITRATE: It is understood that any dispute as to medical malpractice, that is as to whether any medical service rendered under this contract were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered, will be determined by the submission to arbitration as provided by California Law, and not by a lawsuit or resort to court process except as California law provides for judicial review of arbitration proceedings. Both parties to this contract, by entering into it, are giving up their constitutional right to have any dispute decided in a court of law before a jury, and instead, are accepting the use of arbitration.

I hereby acknowledge and agree that I will be responsible to the doctor for payment of entire bill.
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(415) 966-0848 San Francisco,CA

team@ezcareclinic.com

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