Service and support animals

Once people learn about the idea of a “emotional support animal” (ESA) they all want a doctor’s note. Dogs in dorms. Emotional support geckos. What you need is the terminology — and an awareness that the housing rules changed dramatically in 2025–2026.

Service Animals

A service animal is defined by the Americans with Disabilities Act as a dog (and, under a separate provision, sometimes a miniature horse) individually trained to do work or perform tasks directly related to a person’s disability. Guiding, alerting, retrieving, interrupting a panic attack — psychiatric service dogs count, as long as the dog is trained to do something. This lets the handler bring the animal into public places like restaurants and doctor’s offices. No certification, vest, ID card, or documentation is legally required. Print out the excellent government FAQs (https://www.ada.gov/resources/service-animals-faqs/) for patients who ask you for a letter.

When it isn’t obvious, owners may asked exactly two questions — is the dog required because of a disability, and what work or task has it been trained to perform. What they may not do is ask about the disability, demand documentation, or make the dog demonstrate the task. If a patient insists on a letter anyway, ask for documentation from the trainer describing what the animal has been trained to do (loophole: owners can be their own trainers).

Assistance and emotional support animals: housing

This is the request you’ll actually get frequently — a letter so a landlord is obliged to allow a dog in a “no pets” dwelling, or waive a pet fee. It falls under the Fair Housing Act, which covers rental houses, apartments, condos, and college dorms. It does not apply to hotels or other transient lodging, which are public accommodations under the ADA instead. Under the old FHA rules, an assistance animal need not be trained; the questions were whether the person has a disability and whether there is a disability-related need for the animal. That has been the framework for a decade, and it is the framework most of us learned.

It’s the one your patients may not know has changed on May 22, 2026.

What changed. HUD withdrew its 2013 and 2020 assistance-animal guidance in September 2025. On May 22, 2026, its Office of Fair Housing and Equal Opportunity went further, issuing enforcement guidance that aligns its position with the ADA: when a tenant complains that a housing provider refused an animal, HUD will now carry the complaint forward only if the animal was individually trained to perform disability-related work or tasks. Complaints involving untrained emotional support animals are dismissed after investigation. HUD also stopped telling housing providers that they must categorically grant these requests or waive pet fees and deposits, and it has said it intends to conduct formal rulemaking (as of Aug 2026).

What that does and doesn’t mean. This is enforcement policy, not a change in the law. The statute is unchanged, tenants can still sue privately, courts are not bound by a HUD memo, and state fair housing agencies run their own shops. But the practical weight of an ESA letter has dropped sharply, and two things I used to tell patients are no longer safe to say: that a landlord can never charge a pet fee for an assistance animal, and that a letter from their doctor effectively settles the question. What the letter does is document a medical basis for a request. Whether the request is granted is between the patient and the landlord.

North Carolina adds two wrinkles. For public access, Chapter 168, Article 1 of the General Statutes runs parallel to the ADA: a person with a disability may be accompanied by a service animal in the public places listed in G.S. 168-3 and may keep one on any premises they lease or rent, and the same rights extend to a person training a service animal when the animal wears a collar, harness, or cape identifying it as such (G.S. 168-4.2). The statute mentions a ND Department of Health and Human Services (DHHS) registration tag, but a person also qualifies simply by showing the animal is trained or in training — no tag is required, and there is no state registry or certification for emotional support animals, whatever the websites selling them claim. Under G.S. 168-4.5 it is a Class 3 misdemeanor both to deny a service animal access or charge a fee for its use or to disguise an animal as a service animal or a service animal in training — worth mentioning to the patient who wants a vest and a letter for a dog that isn’t trained to do anything. For housing, the State Fair Housing Act (G.S. Chapter 41A) is a separate state law with its own reasonable-accommodation duty and its own complaint route through the North Carolina Human Relations Commission. HUD’s 2026 memo does not bind the Commission or the state courts, so the state channel may prove more favorable to tenants than the federal one, at least until this settles. Patients with a real dispute should go to the Fair Housing Project of Legal Aid of North Carolina (https://www.fairhousingnc.org/) rather than back to you for a longer letter.

Before you write one. The request should rest on an actual evaluation, not on a remark at the end of a visit for something else. Hint: it’s anxiety. It’s always anxiety. So take a real psychiatric history, document the symptoms in the patient’s own words, put the problem on the active problem list, and treat what you find. Then keep all of that out of the letter. If a lawyer ever needs the detail, they can request the office notes — in decades, none ever has requested from me. Be vague, like this:

Ms. Jones has been in the care of our medical practice for many years. I am familiar with her medical history and with the substantial functional limitations of her disability.

Due to her disability, she has certain limitations regarding her ability to cope with stress. In order to help alleviate these difficulties and to enhance her ability to live independently and to fully use and enjoy her home, I am recommending that she have a pet, such as a dog or cat, to act as an assistance animal that will help Ms. Jones manage symptoms associated with her disability.

Further information regarding the obligations of housing providers and tenants can be found at the website of the U.S. Department of Housing and Urban Development.

Thank you for considering this request for a reasonable accommodation.

Note what the letter does not contain: a diagnosis, a medication list, or comments about what the landlord must do. What counts as “reasonable” is open to interpretation, and that interpretation belongs to the landlord, your patient, and the lawyers.

Air travel is a third set of rules, and the answer is no. Since the Department of Transportation’s rule took effect in January 2021, airlines are not required to accommodate emotional support animals at all. Only trained service dogs qualify, and the passenger submits a Department of Transportation (DOT) attestation form rather than a doctor’s letter. Patients still ask; the letter you write won’t help them.