Emotional Support Animal (ESA) Service Terms

Emotional Support Animal (ESA) Service Terms

These terms govern the Emotional Support Animal (ESA) letter evaluation service provided by Altera Health P.C., doing business as Top Tier Psychiatry ("Provider," "we," "us," or "our"). By requesting an ESA evaluation, you ("Patient" or "you") agree to the following terms.

1. Nature of Service

An ESA letter is a professional recommendation issued by a licensed mental health provider following a clinical evaluation. It is not a legal guarantee of housing accommodation. The ESA letter documents a clinical determination that an emotional support animal may benefit your mental health condition as recognized under the Fair Housing Act (42 U.S.C. 3601-3619).

The evaluation is a legitimate clinical assessment conducted by a licensed provider in good standing with the applicable state licensing board.

An ESA letter is a recommendation for an emotional support animal. It is not certification of a service animal. Emotional support animals and service animals are distinct categories under federal and state law, and our office is not able to certify any animal as a service animal.

Your ESA letter speaks only to your clinical need for an emotional support animal. It makes no representation about the animal itself. We do not verify, warrant, or accept responsibility for whether your animal is trained, groomed, vaccinated, in good health, or free from harmful behavior toward people or other animals. Those responsibilities rest solely with you as the animal's owner. Our office does not attend court hearings or serve as a witness in connection with your ESA letter.

2. Fair Housing Act Rights and Limitations

The Fair Housing Act (FHA) requires housing providers to make reasonable accommodations for individuals with disabilities, including allowing emotional support animals in housing with "no pets" policies. Key points:

• Covered housing: Most apartments, condominiums, and rental properties are covered by the FHA.
• Exemptions: Owner-occupied buildings with four or fewer units, single-family homes rented without a broker, and housing operated by religious organizations or private clubs may be exempt.
• Landlord obligations: Landlords may request documentation from a licensed healthcare provider but cannot require specific forms, charge pet fees or deposits for ESAs, or impose breed or weight restrictions on ESAs.
• Your obligations: You must provide documentation when reasonably requested. You remain responsible for any damage caused by your animal.
• Air travel: ESA letters do not guarantee airline accommodation. Since January 2021, airlines are not required to accommodate ESAs under the Air Carrier Access Act. Check individual airline policies.

3. Evaluation Process

The ESA evaluation consists of a brief telehealth appointment with a licensed mental health provider. During this evaluation, the provider will:

• Review your mental health history and current symptoms
• Assess whether an emotional support animal would provide meaningful therapeutic benefit
• Make an independent clinical determination about the appropriateness of an ESA recommendation

The evaluation is conducted in accordance with applicable state telehealth laws and professional standards of care.

4. No-Guarantee Policy

Payment is for the clinical evaluation, not for the letter itself. If the provider determines that an ESA letter is not clinically appropriate based on the evaluation, no letter will be issued. This is a professional clinical judgment and is not subject to appeal.

The provider exercises independent clinical judgment. Neither Altera Health P.C. nor any staff member can influence or override a provider's clinical determination.

5. Fees, Refunds, and Cancellation

• Evaluation fee: The fee displayed at the time of booking covers the cost of the evaluation appointment. This fee is collected in full before the appointment.
• Cancellation (24 hours or more before): You may cancel your appointment at least 24 hours in advance for a full refund of the evaluation fee.
• Late cancellation (less than 24 hours): Cancellations within 24 hours of the appointment will result in forfeiture of the evaluation fee. No refund will be issued.
• No-show (failure to attend): If you fail to attend your scheduled evaluation without canceling, the evaluation fee you paid is forfeited in full. No refund will be issued for missed appointments.
• After evaluation -- letter issued: No refund is available once an ESA letter has been issued and delivered.
• After evaluation -- letter denied: If the provider determines that an ESA letter is not clinically appropriate, you will receive a partial refund of the evaluation fee minus a $25 administrative processing fee.
• Payment dispute disclosure authorization: By using our services, you authorize us to confirm to a payment processor, card network, or financial institution the fact that you received services from us -- and only that fact -- solely in the event you initiate a payment dispute or chargeback that requires adjudication by that processor. No clinical details are disclosed under this authorization.

6. Letter Delivery and Validity

• If approved, your ESA letter package will be emailed to you as PDF attachments. The package includes a professional recommendation letter and a legal certification document.
• ESA letters are valid for one (1) year from the date of issuance.
• You are responsible for presenting the letter to your landlord or property manager as needed.
• Altera Health P.C. does not communicate directly with landlords or property managers on your behalf unless you provide explicit written consent.

7. Privacy and Data Handling

Your ESA evaluation is subject to our Notice of Privacy Practices (HIPAA) and Privacy Policy.

• No medical details shared with landlords: The ESA letter confirms that you have a qualifying condition and that an ESA is part of your treatment. It does not disclose your specific diagnosis, medications, treatment history, or other protected health information.
• Records retention: Your evaluation records are maintained in accordance with applicable state law regarding medical record retention.
• HIPAA compliance: All health information collected during the ESA evaluation process is protected under the Health Insurance Portability and Accountability Act (HIPAA) and applicable state privacy laws.

8. Landlord Interactions

You are responsible for presenting your ESA documentation to your landlord or property manager. If your landlord refuses to accept your ESA letter or fails to make a reasonable accommodation:

• You may file a complaint with the U.S. Department of Housing and Urban Development (HUD) at 1-800-669-9777 or online at hud.gov.
• You may consult a housing rights attorney for legal advice.
• Altera Health P.C. does not provide legal advice, negotiate with landlords, or represent patients in housing disputes.

9. Contact Information

If you have questions about these terms or your ESA evaluation, please contact us:

• Email: info@toptierpsych.com
• Phone: (725) 272-2411
• Mailing Address: P.O. Box 8013, Greensboro, NC 27419

By proceeding with your ESA evaluation request, you acknowledge that you have read, understood, and agree to these terms.