Since the Equality Act 2010 requires landlords to make “reasonable adjustments” for tenants with disabilities, emotional support animals (ESAs) have become an important – and sometimes a contentious aspect of UK rental agreements. Landlords and tenants alike are grappling with how to balance housing policies, animal welfare, and mental-health needs. Here’s a grounded look at how ESAs fit into UK tenancies and the routes available for securing the necessary clinical documentation.

The Rise of Emotional Support Animals in UK Rentals

Over the past decade, awareness of mental-health conditions such as anxiety, depression, and PTSD has grown across the UK. For many, an ESA dog, cat or other companion pet offers comfort that medication or therapy alone may not provide. A confidential survey of 500 renters conducted in early 2025 found that 28% of respondents with a diagnosed mental-health condition had considered an ESA to help manage symptoms.

Yet most standard tenancy agreements contain blanket “no pets” clauses. Under the Equality Act, however, a tenant whose mental-health condition substantially affects normal daily activities can request an exemption, provided they supply a supporting letter from a qualified clinician.

Securing an ESA Letter via the NHS

1. Initial Consultation: Tenants begin by booking an appointment – either face-to-face or via their practice’s telehealth service with their registered NHS GP. Waiting times vary widely by region; some urban practices report a two-week delay for routine appointments.
2. Clinical Assessment: During the consultation, patients explain how an ESA alleviates specific symptoms (e.g., panic attacks, social withdrawal). GPs may review therapy notes or standardised questionnaires to corroborate the claim.
3. Issuing the Letter: If the GP deems the ESA medically necessary, they provide a formal letter on NHS or practice letterhead. This document must state the patient’s diagnosis, explain why an ESA is recommended, and outline how it helps meet clinical goals.
4. Turnaround and Cost: Under NHS guidelines, writing an ESA support letter isn’t part of core NHS clinical work, so many GP surgeries treat it as an optional, non-NHS service. While there’s no official NHS charge for the letter itself, practices commonly impose an “administration fee” typically up to £50 – to cover staff time, printing, postage, and record-keeping. These fees aren’t regulated by the NHS, so costs can vary between surgeries.

An Online Alternative: Remote ESA Documentation

Acknowledging long waits for GP appointments, several digital platforms have emerged to streamline ESA letters. One such service allows users to complete an online questionnaire about their mental-health history and upload any existing therapy notes. A GMC-registered GP reviews the submission and, if approved, issues a digitally signed letter – typically within 24–48 hours. More details can be found on their ESA documentation page. While faster, these services sit outside the NHS framework and usually charge a one-off fee (approximately £20 – £50). 

Negotiating Tenancy Agreements

Once equipped with an ESA letter, tenants should:

• Notify Early: Present the letter before signing or renewing a lease to give landlords time to consider the request.
• Provide Assurances: Offer vaccination records, details of the animal’s training, and a clear plan for waste removal and noise control.
• Document Communications: Keep written records of any email or letter exchanges to establish a paper trail in case of disputes.

Landlords retain the right to refuse if the request is unreasonable (for example, keeping a large dog in a small flat where it could distress neighbours). For guidance on living arrangements and pet etiquette, tenants can consult resources such as this living with a companion pet guide, and practical tips on renting with pets.

Looking Ahead

As more tenants and landlords navigate ESA requests, both NHS surgeries and private providers are under pressure to clarify procedures and reduce waiting times. In the meantime, renters with genuine clinical need must balance speed, cost, and credibility when choosing between the traditional NHS route and online alternatives. With clear documentation and open communication, most requests can be accommodated