Home
About
Emergency
Services
Client Information
Contact
Call/Text: (919) 844-9166

Home
About
Emergency
Services
Client Information
Contact
Call/Text: (919) 844-9166

Avian Flu in North Carolina – Click here to find out what you can do to protect your pets, and what we are doing to protect our patients.

New Client Form

Save time during your first appointment at Avian and Exotic Animal Care. Complete your new client form online from any device at any time before your visit.

Get Started

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

CLIENT INFORMATION

Date *

Name *

First

Last

D.O.B *

Spouse's Name

First

Last

Driver's License Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

United States+1
United Kingdom+44
Afghanistan+93
Åland Islands+358
Albania+355
Algeria+213
American Samoa+1
Andorra+376
Angola+244
Anguilla+1
Antigua & Barbuda+1
Argentina+54
Armenia+374
Aruba+297
Ascension Island+247
Australia+61
Austria+43
Azerbaijan+994
Bahamas+1
Bahrain+973
Bangladesh+880
Barbados+1
Belarus+375
Belgium+32
Belize+501
Benin+229
Bermuda+1
Bhutan+975
Bolivia+591
Bosnia & Herzegovina+387
Botswana+267
Brazil+55
British Indian Ocean Territory+246
British Virgin Islands+1
Brunei+673
Bulgaria+359
Burkina Faso+226
Burundi+257
Cambodia+855
Cameroon+237
Canada+1
Cape Verde+238
Caribbean Netherlands+599
Cayman Islands+1
Central African Republic+236
Chad+235
Chile+56
China+86
Christmas Island+61
Cocos (Keeling) Islands+61
Colombia+57
Comoros+269
Congo - Brazzaville+242
Congo - Kinshasa+243
Cook Islands+682
Costa Rica+506
Côte d’Ivoire+225
Croatia+385
Cuba+53
Curaçao+599
Cyprus+357
Czechia+420
Denmark+45
Djibouti+253
Dominica+1
Dominican Republic+1
Ecuador+593
Egypt+20
El Salvador+503
Equatorial Guinea+240
Eritrea+291
Estonia+372
Eswatini+268
Ethiopia+251
Falkland Islands+500
Faroe Islands+298
Fiji+679
Finland+358
France+33
French Guiana+594
French Polynesia+689
Gabon+241
Gambia+220
Georgia+995
Germany+49
Ghana+233
Gibraltar+350
Greece+30
Greenland+299
Grenada+1
Guadeloupe+590
Guam+1
Guatemala+502
Guernsey+44
Guinea+224
Guinea-Bissau+245
Guyana+592
Haiti+509
Honduras+504
Hong Kong SAR China+852
Hungary+36
Iceland+354
India+91
Indonesia+62
Iran+98
Iraq+964
Ireland+353
Isle of Man+44
Israel+972
Italy+39
Jamaica+1
Japan+81
Jersey+44
Jordan+962
Kazakhstan+7
Kenya+254
Kiribati+686
Kosovo+383
Kuwait+965
Kyrgyzstan+996
Laos+856
Latvia+371
Lebanon+961
Lesotho+266
Liberia+231
Libya+218
Liechtenstein+423
Lithuania+370
Luxembourg+352
Macao SAR China+853
Madagascar+261
Malawi+265
Malaysia+60
Maldives+960
Mali+223
Malta+356
Marshall Islands+692
Martinique+596
Mauritania+222
Mauritius+230
Mayotte+262
Mexico+52
Micronesia+691
Moldova+373
Monaco+377
Mongolia+976
Montenegro+382
Montserrat+1
Morocco+212
Mozambique+258
Myanmar (Burma)+95
Namibia+264
Nauru+674
Nepal+977
Netherlands+31
New Caledonia+687
New Zealand+64
Nicaragua+505
Niger+227
Nigeria+234
Niue+683
Norfolk Island+672
North Korea+850
North Macedonia+389
Northern Mariana Islands+1
Norway+47
Oman+968
Pakistan+92
Palau+680
Palestinian Territories+970
Panama+507
Papua New Guinea+675
Paraguay+595
Peru+51
Philippines+63
Poland+48
Portugal+351
Puerto Rico+1
Qatar+974
Réunion+262
Romania+40
Russia+7
Rwanda+250
Samoa+685
San Marino+378
São Tomé & Príncipe+239
Saudi Arabia+966
Senegal+221
Serbia+381
Seychelles+248
Sierra Leone+232
Singapore+65
Sint Maarten+1
Slovakia+421
Slovenia+386
Solomon Islands+677
Somalia+252
South Africa+27
South Korea+82
South Sudan+211
Spain+34
Sri Lanka+94
St. Barthélemy+590
St. Helena+290
St. Kitts & Nevis+1
St. Lucia+1
St. Martin+590
St. Pierre & Miquelon+508
St. Vincent & Grenadines+1
Sudan+249
Suriname+597
Svalbard & Jan Mayen+47
Sweden+46
Switzerland+41
Syria+963
Taiwan+886
Tajikistan+992
Tanzania+255
Thailand+66
Timor-Leste+670
Togo+228
Tokelau+690
Tonga+676
Trinidad & Tobago+1
Tunisia+216
Turkey+90
Turkmenistan+993
Turks & Caicos Islands+1
Tuvalu+688
U.S. Virgin Islands+1
Uganda+256
Ukraine+380
United Arab Emirates+971
Uruguay+598
Uzbekistan+998
Vanuatu+678
Vatican City+39
Venezuela+58
Vietnam+84
Wallis & Futuna+681
Western Sahara+212
Yemen+967
Zambia+260
Zimbabwe+263

Secondary Phone

United States+1
United Kingdom+44
Afghanistan+93
Åland Islands+358
Albania+355
Algeria+213
American Samoa+1
Andorra+376
Angola+244
Anguilla+1
Antigua & Barbuda+1
Argentina+54
Armenia+374
Aruba+297
Ascension Island+247
Australia+61
Austria+43
Azerbaijan+994
Bahamas+1
Bahrain+973
Bangladesh+880
Barbados+1
Belarus+375
Belgium+32
Belize+501
Benin+229
Bermuda+1
Bhutan+975
Bolivia+591
Bosnia & Herzegovina+387
Botswana+267
Brazil+55
British Indian Ocean Territory+246
British Virgin Islands+1
Brunei+673
Bulgaria+359
Burkina Faso+226
Burundi+257
Cambodia+855
Cameroon+237
Canada+1
Cape Verde+238
Caribbean Netherlands+599
Cayman Islands+1
Central African Republic+236
Chad+235
Chile+56
China+86
Christmas Island+61
Cocos (Keeling) Islands+61
Colombia+57
Comoros+269
Congo - Brazzaville+242
Congo - Kinshasa+243
Cook Islands+682
Costa Rica+506
Côte d’Ivoire+225
Croatia+385
Cuba+53
Curaçao+599
Cyprus+357
Czechia+420
Denmark+45
Djibouti+253
Dominica+1
Dominican Republic+1
Ecuador+593
Egypt+20
El Salvador+503
Equatorial Guinea+240
Eritrea+291
Estonia+372
Eswatini+268
Ethiopia+251
Falkland Islands+500
Faroe Islands+298
Fiji+679
Finland+358
France+33
French Guiana+594
French Polynesia+689
Gabon+241
Gambia+220
Georgia+995
Germany+49
Ghana+233
Gibraltar+350
Greece+30
Greenland+299
Grenada+1
Guadeloupe+590
Guam+1
Guatemala+502
Guernsey+44
Guinea+224
Guinea-Bissau+245
Guyana+592
Haiti+509
Honduras+504
Hong Kong SAR China+852
Hungary+36
Iceland+354
India+91
Indonesia+62
Iran+98
Iraq+964
Ireland+353
Isle of Man+44
Israel+972
Italy+39
Jamaica+1
Japan+81
Jersey+44
Jordan+962
Kazakhstan+7
Kenya+254
Kiribati+686
Kosovo+383
Kuwait+965
Kyrgyzstan+996
Laos+856
Latvia+371
Lebanon+961
Lesotho+266
Liberia+231
Libya+218
Liechtenstein+423
Lithuania+370
Luxembourg+352
Macao SAR China+853
Madagascar+261
Malawi+265
Malaysia+60
Maldives+960
Mali+223
Malta+356
Marshall Islands+692
Martinique+596
Mauritania+222
Mauritius+230
Mayotte+262
Mexico+52
Micronesia+691
Moldova+373
Monaco+377
Mongolia+976
Montenegro+382
Montserrat+1
Morocco+212
Mozambique+258
Myanmar (Burma)+95
Namibia+264
Nauru+674
Nepal+977
Netherlands+31
New Caledonia+687
New Zealand+64
Nicaragua+505
Niger+227
Nigeria+234
Niue+683
Norfolk Island+672
North Korea+850
North Macedonia+389
Northern Mariana Islands+1
Norway+47
Oman+968
Pakistan+92
Palau+680
Palestinian Territories+970
Panama+507
Papua New Guinea+675
Paraguay+595
Peru+51
Philippines+63
Poland+48
Portugal+351
Puerto Rico+1
Qatar+974
Réunion+262
Romania+40
Russia+7
Rwanda+250
Samoa+685
San Marino+378
São Tomé & Príncipe+239
Saudi Arabia+966
Senegal+221
Serbia+381
Seychelles+248
Sierra Leone+232
Singapore+65
Sint Maarten+1
Slovakia+421
Slovenia+386
Solomon Islands+677
Somalia+252
South Africa+27
South Korea+82
South Sudan+211
Spain+34
Sri Lanka+94
St. Barthélemy+590
St. Helena+290
St. Kitts & Nevis+1
St. Lucia+1
St. Martin+590
St. Pierre & Miquelon+508
St. Vincent & Grenadines+1
Sudan+249
Suriname+597
Svalbard & Jan Mayen+47
Sweden+46
Switzerland+41
Syria+963
Taiwan+886
Tajikistan+992
Tanzania+255
Thailand+66
Timor-Leste+670
Togo+228
Tokelau+690
Tonga+676
Trinidad & Tobago+1
Tunisia+216
Turkey+90
Turkmenistan+993
Turks & Caicos Islands+1
Tuvalu+688
U.S. Virgin Islands+1
Uganda+256
Ukraine+380
United Arab Emirates+971
Uruguay+598
Uzbekistan+998
Vanuatu+678
Vatican City+39
Venezuela+58
Vietnam+84
Wallis & Futuna+681
Western Sahara+212
Yemen+967
Zambia+260
Zimbabwe+263

Email Address *

Contact Preference

Text
Voicemail
Email

How were you referred to our hospital? *

PET INFORMATION

Pet's Name *

Breed *

Birth/Hatch Date/Approximate Age *

Sex *

Male
Female

Color *

How long have you had your pet? *

Heartworm Test/Prevention *

Do you have another pet?

Pet's Name *

Breed *

Birth/Hatch Date/Approximate Age *

Sex *

Male
Female

Color *

How long have you had your pet? *

Heartworm Test/Prevention *

Do you have another pet?

Pet's Name *

Breed *

Birth/Hatch Date/Approximate Age *

Sex *

Male
Female

Color *

How long have you had your pet? *

Heartworm Test/Prevention *

Any previous records? *

Any allergies to vaccinations or medications? *

Is your pet on any special diets or medications? *

I have been advised that for safety reasons, my pet, upon arriving or leaving AEAC, must be either restrained appropriately or in a carrier. *Failure to follow this policy, may result in my pet’s harm by other patients in the reception area. *

I have read and agree AEAC's policy

By signing this form, I am stating that I am over the age of 18yrs. *

Yes, I am over the age of 18
No, I am not over the age of 18

By signing this form, I am stating that I am over the age of 18yrs. *

Yes, I'm over the age of 18
No, I'm not over the age of 18

Our goal at Avian and Exotic Animal Care is to give excellent service in a timely manner. Due to the nature of emergencies, which may need urgent and immediate care, we may ask for your patience. We will keep you informed regarding wait times and offer you other options. *

I have read and agree to the following

Avian and Exotic Animal Care respects your privacy and we are committed to protect the personal information that you share with us. Personal information is defined as information that can be used to identify you, or your pet, and to contact you. Your personal information will never be given out, sold, or shared with third parties, with the exception of outside laboratories/consultants for the purpose of diagnostics for your pet. We are committed to making you feel comfortable as our client and we understand how important your pet’s health is and that your pet’s health is a personal and private subject. If you have any questions or concerns regarding the privacy of your personal information please do not hesitate to ask any member of our team. *

I have read and agree to the following

AVIAN AND EXOTIC ANIMAL CARE EXPECTS PAYMENT IN FULL AT THE TIME SERVICES ARE RENDERED. We accept cash, credit cards, and Care Credit. For extensive diagnostics, hospitalization, and surgery, we will provide you with a Treatment Plan. If your pet is left with us for any reason, please be prepared to pay in advance for your pet’s care per the Treatment Plan. Should you choose, we can take credit card payment over the phone, with proper documentation. LATE PAYMENTS OF OVER 30 DAYS ARE SUBJECT TO FINANCE CHARGES PER MONTH, AND OUTSTANDING CHARGES MAY BE SENT TO COLLECTIONS. *

I have read and agree to the following

Client Signature *

Clear Signature

We also understand that unplanned issues can come up and you may need to cancel or move your appointment. If that happens, we respectfully ask for scheduled appointments to be cancelled at least 24hrs in advance. Our veterinarians want to be available to all of our patients. When clients do not show up, another patient loses the opportunity to be seen. Although we have always had a cancellation policy, circumstances have caused us to enforce a policy of charging for Late arrivals, No Shows, and appointments not cancelled with 24hr notice. As of November 2024, there are now charges for the following: Late appointments, No-Shows or failure to cancel with 24 hour notice, or Late, No-Shows, and Cancellations within 24 hours for SURGERIES or PRIMATE APPOINTMENTS, due to extra preparation for these specific visits. *

I have read and agree to the following

All Late, No Show, or failure to cancel fees must be paid before further services are completed. *

I have read and agree to the following

Thank you for being a valued client and for entrusting your pet to our care. Thank you also for your understanding and cooperation as we institute this policy. Our hope is to open otherwise unused appointment slots for those urgent pets that need to be seen and to better serve all of our clients and patients’ needs.

Please Initial *

Date *

PHOTO & CONTENT RELEASE FORM

At Avian and Exotic Animal Care, we enjoy sharing our patients’ photos and stories within our hospital & online. We would love your permission to share your pet’s image & story. Sharing stories is simply a fun way to assist us in educating other pet owners about pet health. Help us by reviewing the statement below: I hereby grant Avian and Exotic Animal Care the right to photograph my pet and copyright, use & publish said images. Publication includes both print and electronic publication, including – but not limited to – our website, our blog & our social media. I grant Avian and Exotic Animal Care the right to copyright, use and publish my pet’s story for any lawful purpose, including – but not limited to – social media content, blog content and education content. *

I AGREE and give Avian and Exotic Animal Care the right to share my pet’s photo/story.
I DISAGREE. Please do not share my pet’s photo/story.

Pet(s) Name *

Client Name (Printed) *

Client Signature *

Clear Signature

Comment

We proudly serve the exotic pets of Raleigh, NC, and beyond.

Our mission is to nurture the human-animal bond by providing compassionate, expert care for exotic pets throughout their lives. Through education, research, and advanced medicine, we focus on species often overlooked, ensuring all pets receive the care they deserve.

Call/Text: (919) 844-9166



Location

8711 Fidelity Boulevard
Raleigh, NC 27617



Contact

Phone: (919) 844-9166
Fax: (919) 844-0925
Email: info@avianandexotic.com



Hours

Mon – Fri: 8 AM – 6 PM
Sat: 8 AM – 1 PM
Sun: Closed

Have a question?

Please complete our online form and a member of our team will get back to you as quickly as possible.

Name *

First

Last

Email *

Phone

United States+1
United Kingdom+44
Afghanistan+93
Åland Islands+358
Albania+355
Algeria+213
American Samoa+1
Andorra+376
Angola+244
Anguilla+1
Antigua & Barbuda+1
Argentina+54
Armenia+374
Aruba+297
Ascension Island+247
Australia+61
Austria+43
Azerbaijan+994
Bahamas+1
Bahrain+973
Bangladesh+880
Barbados+1
Belarus+375
Belgium+32
Belize+501
Benin+229
Bermuda+1
Bhutan+975
Bolivia+591
Bosnia & Herzegovina+387
Botswana+267
Brazil+55
British Indian Ocean Territory+246
British Virgin Islands+1
Brunei+673
Bulgaria+359
Burkina Faso+226
Burundi+257
Cambodia+855
Cameroon+237
Canada+1
Cape Verde+238
Caribbean Netherlands+599
Cayman Islands+1
Central African Republic+236
Chad+235
Chile+56
China+86
Christmas Island+61
Cocos (Keeling) Islands+61
Colombia+57
Comoros+269
Congo - Brazzaville+242
Congo - Kinshasa+243
Cook Islands+682
Costa Rica+506
Côte d’Ivoire+225
Croatia+385
Cuba+53
Curaçao+599
Cyprus+357
Czechia+420
Denmark+45
Djibouti+253
Dominica+1
Dominican Republic+1
Ecuador+593
Egypt+20
El Salvador+503
Equatorial Guinea+240
Eritrea+291
Estonia+372
Eswatini+268
Ethiopia+251
Falkland Islands+500
Faroe Islands+298
Fiji+679
Finland+358
France+33
French Guiana+594
French Polynesia+689
Gabon+241
Gambia+220
Georgia+995
Germany+49
Ghana+233
Gibraltar+350
Greece+30
Greenland+299
Grenada+1
Guadeloupe+590
Guam+1
Guatemala+502
Guernsey+44
Guinea+224
Guinea-Bissau+245
Guyana+592
Haiti+509
Honduras+504
Hong Kong SAR China+852
Hungary+36
Iceland+354
India+91
Indonesia+62
Iran+98
Iraq+964
Ireland+353
Isle of Man+44
Israel+972
Italy+39
Jamaica+1
Japan+81
Jersey+44
Jordan+962
Kazakhstan+7
Kenya+254
Kiribati+686
Kosovo+383
Kuwait+965
Kyrgyzstan+996
Laos+856
Latvia+371
Lebanon+961
Lesotho+266
Liberia+231
Libya+218
Liechtenstein+423
Lithuania+370
Luxembourg+352
Macao SAR China+853
Madagascar+261
Malawi+265
Malaysia+60
Maldives+960
Mali+223
Malta+356
Marshall Islands+692
Martinique+596
Mauritania+222
Mauritius+230
Mayotte+262
Mexico+52
Micronesia+691
Moldova+373
Monaco+377
Mongolia+976
Montenegro+382
Montserrat+1
Morocco+212
Mozambique+258
Myanmar (Burma)+95
Namibia+264
Nauru+674
Nepal+977
Netherlands+31
New Caledonia+687
New Zealand+64
Nicaragua+505
Niger+227
Nigeria+234
Niue+683
Norfolk Island+672
North Korea+850
North Macedonia+389
Northern Mariana Islands+1
Norway+47
Oman+968
Pakistan+92
Palau+680
Palestinian Territories+970
Panama+507
Papua New Guinea+675
Paraguay+595
Peru+51
Philippines+63
Poland+48
Portugal+351
Puerto Rico+1
Qatar+974
Réunion+262
Romania+40
Russia+7
Rwanda+250
Samoa+685
San Marino+378
São Tomé & Príncipe+239
Saudi Arabia+966
Senegal+221
Serbia+381
Seychelles+248
Sierra Leone+232
Singapore+65
Sint Maarten+1
Slovakia+421
Slovenia+386
Solomon Islands+677
Somalia+252
South Africa+27
South Korea+82
South Sudan+211
Spain+34
Sri Lanka+94
St. Barthélemy+590
St. Helena+290
St. Kitts & Nevis+1
St. Lucia+1
St. Martin+590
St. Pierre & Miquelon+508
St. Vincent & Grenadines+1
Sudan+249
Suriname+597
Svalbard & Jan Mayen+47
Sweden+46
Switzerland+41
Syria+963
Taiwan+886
Tajikistan+992
Tanzania+255
Thailand+66
Timor-Leste+670
Togo+228
Tokelau+690
Tonga+676
Trinidad & Tobago+1
Tunisia+216
Turkey+90
Turkmenistan+993
Turks & Caicos Islands+1
Tuvalu+688
U.S. Virgin Islands+1
Uganda+256
Ukraine+380
United Arab Emirates+971
Uruguay+598
Uzbekistan+998
Vanuatu+678
Vatican City+39
Venezuela+58
Vietnam+84
Wallis & Futuna+681
Western Sahara+212
Yemen+967
Zambia+260
Zimbabwe+263

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