Digital Support Intake Form -

Full Name

Please enter your full name as it appears.

This field is required.

Email Address

Please provide a valid email address for communication.

This field is required.

Phone Number (Optional)

Please provide your phone number if you’d prefer to be contacted via phone.

This field is required.

Preferred Contact Method

Please select your preferred method of contact.

Email

Phone

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What type of digital support do you need?

Select all support services that apply to your request.

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Please describe the issue or support request in detail

Be as specific as possible to help me understand your needs.

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Is this a one-time task or ongoing support?

Let me know if this is a one-time project or ongoing support.

One-time

Ongoing

Not sure yet

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Do you have a deadline or preferred timeline?

If applicable, please specify your timeline for this request.

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Please share any relevant links, usernames, or account details (do not include passwords)

Include any necessary information that will assist us in resolving your request.

How did you hear about my services?

Please let us know how you found out about my services.