Malware Removal Intake Form
Please provide details about the affected device, symptoms, recent activity, and any available evidence so the malware issue can be assessed and remediated.
Client & Contact Information
Full Name
*
First Name
Middle Name
Last Name
Organization / Company Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone
Either
Best Time to Contact
Device & Environment Details
Device type
*
Please Select
Desktop
Laptop
Server
Mobile device
Other
Operating system and version
*
Device hostname or label
Browser name and version (if relevant)
Device ownership
*
Personal
Company-owned
Shared
Other
Infection Symptoms & Scope
When did the issue start?
*
-
Month
-
Day
Year
Date
How many devices are affected?
*
One device
Multiple devices
Not sure
Observed signs
*
Pop-up ads or alerts
Browser redirects
Slow performance
Unknown programs or extensions
Security tools disabled
Suspicious emails
Unexpected file changes
Locked files
Other
Describe what happened in your own words
Security Software & Recent Activity
Current antivirus or endpoint protection product
Is security software installed and active?
*
Yes
No
Not sure
Last update or scan date and time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Recent actions before the issue began
Downloaded files
Opened email attachments
Installed software
Visited suspicious websites
Used external drives
Clicked on links in messages
Other
Access & Recovery Information
Do you still have access to the device?
*
Yes
No
Are you experiencing account lockout or sign-in issues?
*
Yes
No
Are any files encrypted or inaccessible?
*
Yes
No
Backup available?
*
Please Select
Yes, recent backup available
Yes, but unsure how current it is
No backup available
Not sure
Other
Recovery notes or special concerns
Files, Evidence & Attachments
Upload Evidence Files
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Describe Each Attachment and Where It Came From
Submit Intake
Should be Empty: