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Intake form
Help us serve you better
Name
*
Email address
*
What type of device do you need help with?
Please select at least one option.
Computer
Smartphone
Tablet
Printer
Router
What specific issue are you experiencing?
What operating system are you using?
Select
Windows
macOS
Linux
iOS
Android
Preferred method of contact
Select
Phone
Email
Text
What days are you available for assistance?
Please select at least one option.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time works best for you?
Please select at least one option.
2 PM - 3 PM
3 PM - 4 PM
4 PM - 5 PM
5 PM - 6 PM
6 PM - 7 PM
Do you require assistance with setting up wi-fi?
Select
Yes
No
Are you interested in tech tutoring sessions?
Select
Yes
No
Which service or services are you interested in?
Please select at least one option.
Computer Help or Setup
Smartphone help
Tech tutoring for seniors
Additional questions or comments
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