Free Analysis Assessment Tool [Consumer] Step 1 of 9 11% How our process works: Set aside 5-10 minutes to complete the following form. Once completed, our Fair Housing Team will review your answers, and respond via email usually within five business days. About youName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email GeneralDo you receive Social Security Disability Income or VA income?*YesNoDid the alleged discriminatory act happen within the last 365 days?*YesNo AccommodationDo you have written proof of providing your ESA letter to the property?*YesNoWritten proof can be email, fax, text message, or tracking number for mail delivery.Do you have written proof of requesting an accommodation from the property?*YesNoDo you have proof of being denied the accommodation you requested?*YesNoHave you been denied due to the property’s breed, weight, or size restrictions?*YesNoDo you have possession of any written rules, regulations, policies, or procedures which you think might be discriminatory?*YesNoDid your property/landlord accidentally discover your assistance animal?*YesNoUpload documentation received from your landlord (if available)Accepted file types: pdf, doc, docx. Clinician/physicianIs your clinician licensed and located in your state of residence?*YesNoProvided you a letter verifying the need for an assistance animal within the past 24 months?*YesNo ESA LetterDid you purchase an ESA letter from an out-of-state online vendor?*YesNoDo you have a written ESA letter from a medical provider who would confidently state that you are a patient of theirs, or would confidently state they have diagnosed you with a mental/psychological disability?*YesNoWere you required to pay for any of the following: additional pet insurance, training, ESA or Service Animal Registration for a certificate, or service animal vest?*YesNoUpload your ESA letter.Accepted file types: pdf, doc, docx. Assistance AnimalIs your assistance animal either a dog, cat, or bird?*YesNoIs your assistance animal accused of biting, nipping, lunging at any person, or being aggressive?*YesNo HousingDid the alleged housing discrimination occur at a hotel, motel, RV park or any other temporary housing?*YesNoDo you rent a room from your landlord and your landlord lives in the same unit/house/condo?*YesNoDo you have at least one fine/notice for not cleaning up after your assistance animal?*YesNoDo you have at least one fine/notice which accuses your animal of being a nuisance for excessive barking etc.?*YesNoAre you behind on your rent, or have you refused to pay rent, or behind on fines & penalties to the property?*YesNoDo you rent a unit from a small landlord who rents a total number of four units or less?*YesNo Contact PreferencesRelease contact info to interested member lawyers?*Please selectYesNoBy submitting this form, you agree to our Terms and Conditions. This iframe contains the logic required to handle Ajax powered Gravity Forms.