Psychiatric/Therapeutic/Emotional Support Animal Instructions

All forms must be completed before submission.

General information:

United requires a passenger who is a qualified individual with a disability within the meaning of Department of Transportation Rules (Part 382) who wishes to fly with a psychiatric service or emotional support animal to obtain and submit documentation: 1) from a licensed medical/mental health professional, 2) from a licensed veterinary professional and 3) a Passenger Confirmation of Liability and Emotional Support/Psychiatric Service Animal Behavior.

Instructions:

Passenger:

Please submit completed forms as soon as possible to the United Airlines Accessibility Desk by email (uaaeromed@united.com) including first departure date and the flight confirmation (a six-character place alphanumeric code) in the subject line. Documentation must be received no later than 48 hours prior to travel for documentation verification. Please retain the original forms in your possession while traveling and be prepared to present them to airline representatives if requested.

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.

Emotional Support/Psychiatric Service Animal Request

Must be completed by a licensed mental health professional (e.g. psychiatrist, psychologist, licensed clinical social worker) including a medical doctor specifically treating the passenger’s mental or emotional disability

(Note: In completing this form, please refer to definitions below.)

Passenger/patient name (print):

Animal type:

Animal breed:

Your initials here

I certify that the passenger has a mental or emotional disability listed in the Diagnostic and Statistical Manual of Mental Disorders.

Your initials here

I am a licensed medical/mental health professional currently treating the passenger's mental or emotional disability.

Your initials here

The passenger is under my current and ongoing professional care.

Your initials here

I have prescribed treatment that requires the animal identified above to accompany the passenger to accommodate his/her mental or emotional disability in the following manner (check one only):

outside of a kennel or carrier in the aircraft cabin during flight

inside of a kennel or carrier in the aircraft cabin during flight

at the passenger’s final destination only (need not be transported in aircraft cabin)

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:

Business email contact:

Definitions – As used on this form, the following terms have the meanings indicated:

*A mental or emotional disability means a mental impairment that, on a permanent or temporary basis, substantially limits one or more major life activities (see definition below), and includes any mental or psychological disorder, such as an intellectual disability, organic brain syndrome, emotional or mental illness, and specific learning disabilities, including but not limited to such conditions as emotional illness, drug addiction, and alcoholism.

Major life activities means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.

Passenger Confirmation of Liability and Emotional Support/Psychiatric Service Animal Behavior

Must be completed by passenger

Passenger name (print):

Animal Type:

Animal Breed:

Weight if over 20 pounds only:

Your initials here

I am not aware of any reason to believe that this animal would pose a direct threat to the health or safety of others.

Your initials here

I am not aware of any reason to believe that this animal would cause a significant disruption to service in an aircraft cabin.

Your initials here

I am not aware of any reason to believe that this animal would be too large or heavy to be accommodated under the seat/foot space onboard a typical airline aircraft.

Your initials here

If outside of a kennel,
- this animal takes direction upon my command and will remain under my control at all times, and
- I confirm that this animal has been trained to behave properly in a public setting.

Your initials here

I understand that if my animal acts inappropriately or exhibits unsafe or untrained behavior, United Airlines may only accept it in accordance with its current pet policies, may deny the animal boarding, and/or remove it from the aircraft.

Your initials here

I assume full responsibility for the safety, well-being, and conduct of my animal, including the interaction of the animal with crew and other passengers or passenger property that may come in contact with the animal while on board the aircraft, and for compliance with all UA and governmental requirements, regulations, or restrictions, including entry permits and required health certificates of the country, state, or territory from and/or to which the animal is being transported.

By failing to comply if I cause United Airlines or its passengers any loss, damage, or expense of any kind, I consent and acknowledge that I will reimburse it for any such loss, damage, or expense.

Signature and date:

Phone contact:

Email contact:

Veterinary Health Form

Must be completed by a licensed veterinary professional

Passenger/patient name (print)

Animal Type:

Animal Breed:

Animal Weight (if over 20 pounds):

Your initials here

Your initials here

The animal is current as of the date of this form for the following vaccinations:

Rabies Vaccine (if applicable to this type of animal)

Date given: ____________

Distemper Vaccine (if applicable to this type of animal)

Date given: ____________

Your initials here

I am not aware of any reason to believe that this animal would pose a direct threat to the health or safety of others.

What measures, if any, would be helpful to safely carry this animal in the aircraft cabin: (please check all that apply)

a. Kennel

b. Muzzle

c. This animal should only travel in cargo hold.

d. Other: .

Veterinary 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:

Business email contact: