Secure Client Intake

This secure intake gives us what we need to begin your service. If you haven’t chosen and paid for a service yet, start on the Packages page — then come back here to complete your intake.

Before you submit, please read our Services Agreement & Terms. Submitting this form confirms that you have read and agree to them, and that your request is for your own personal safety — not to locate, monitor, or pursue anyone, and not for employment, tenant, or credit decisions.

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Thank you for your response. ✨

Which service are you requesting?

Your name

Your email

Your phone

What prompted this? Tell us what’s going on.

Details about the subject or situation — names, usernames or profile links, photos you can share (paste links), phone, email, platform, and anything else you have.

Any deadline or time pressure? (e.g., a meeting date, or money about to move)

I am requesting this for my own personal safety in a personal relationship or situation — not for employment, tenant, or credit decisions, and not to locate, monitor, or pursue anyone.

I have read and agree to the Services Agreement and Terms.

In an active crisis right now? Don’t wait for the form — email contact@countervailintelligence.com.