Virus Removal & Cleanup Service – Intake
Full Name
*
Phone Number
*
Used for appointment confirmation and technician updates.
Best Email for Updates
*
Preferred Service Type
*
Onsite (Home / Office)
Remote Support
Drop-off
Choose how you would prefer to receive service.
Service Address (for onsite)
Only required for onsite service.
City & State (optional)
ZIP Code
*
Allows us to verify service availability in your area.
Device Type
*
Desktop Computer
Laptop
All-in-One
Other / Not Sure
Operating System
*
Windows 10
Windows 11
macOS
Other / Not Sure
Brand / Model (optional)
Symptoms / Issue(s)
*
Computer is very slow or freezing
Pop-ups or unwanted advertisements
Browser redirects or homepage changed
Unknown programs or toolbars appeared
Antivirus warning / malware detected
Suspicious emails or account activity
Files missing, changed, or encrypted
Ransomware message or payment demand
Computer will not boot normally
Other
Can You Still Access the Computer Normally?
*
Yes
Yes, but it is very slow or unstable
No — Windows/macOS will not load
No — device will not power on
Not Sure
Is Antivirus / Security Software Currently Installed?
*
Yes
No
Expired / Not Working
Not Sure
Describe the Problem in Detail
*
What Have You Already Tried?
Restarted the computer
Ran antivirus scan
Ran anti-malware software
Uninstalled suspicious software
Reset browser settings
Booted into Safe Mode
Nothing yet
Is Important Data Stored on This Computer?
*
Yes — important files are on the computer
Yes — but I already have a backup
No important files
Not Sure
Additional Cleanup / Security Services (optional)
Remove unwanted programs / bloatware
Browser cleanup and reset
Startup optimization
Install / configure antivirus protection
Operating system and security updates
Security health check after cleanup
Data backup before cleanup
Other
Preferred Date of Service
*
Preferred Time Window
*
Morning (9 AM – 12 PM)
Afternoon (12 PM – 3 PM)
Evening (3 PM – 6 PM)
Anytime
Is This Request Urgent?
Yes, as soon as possible
No, flexible
Just getting a quote
Notes for Technician (optional)
Acknowledgment & Consent
*
I understand that diagnostics may be required before final pricing can be provided, and that malware removal cannot guarantee recovery of files already damaged or encrypted.
If you are human, leave this field blank.
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