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.

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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.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

Who Can We Thank for Referring You to Us? *

Pet Information

Pet's Name

Breed/Exotic Species

Sex

Male
Female

I authorize Avian and Exotic Animal Care to obtain my named pets medical history and records to best treat my pet. *

Yes, I authorize the release of my pet's medical records.

Additional Pet Information

Signature *

Clear Signature

Date: *

Email

New Client Form

New Client Form

Pet Information

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

Location

Contact

Hours

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