Psychiatric/Therapeutic/Emotional Support Animal Authorization
General information:
Pursuant to the Department of Transportation (DOT) guidance for the carriage of service animals, United requires a passenger with a qualified disability traveling with a psychiatric/therapeutic/emotional support type animal to obtain documentation from their medical/mental health professional. Instructions:
Medical/mental health professional: Please complete this form or provide the passenger with a written statement containing the information on this form on your practice letterhead.
Passenger: Send a copy of the form or written statement to the United Airlines Accessibility Desk by fax (872-825-0208) or email (uaaeromed@united.com) 48 hours prior to travel for documentation verification (by contacting your health care professional). Please retain the original form or your medical/mental health professional statement in your possession while traveling and be prepared to present it to airline representatives.
Accessibility Desk: Verify documentation. Complete SSR in the PNR with ESAN APPROVED or NOT APPROVED and your name.
Airport Agent: Verify the passenger's documentation and SSR information in the PNR. Verify the animal meets the requirements (i.e., behavior) to travel in the passenger cabin free of charge.
Note: With respect to an animal used to assist a qualified individual with a disability, the animal must be trained to behave appropriately in a public setting. Animals found not to have been trained to behave will only be accepted in accordance with United's current pet policies or may be denied boarding.
Initial Must be completed by medical/mental health professional
_______ I certify that the passenger has a mental health-related disability listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
_______ Having the animal accompany the passenger is necessary to the passenger's mental health or treatment.
_______ I am a licensed medical/mental health professional treating the passenger's mental or emotional disability.
_______ The passenger is under my professional care.
Medical/mental health professional's license information:

Date and type of the license:________________________________

License Number:________________________________

State or other jurisdiction in which license was issued:________________________________

Your name (print):

Signature and date:

Business phone contact:

Passenger/patient name (print):
Animal type, breed and weight: