JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PCRx self-serve intake form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Are you a BCIT student or faculty member?
*
Yes, I'm a student.
Yes, I'm a faculty member.
No.
What's your name?
*
Your answer
What's wrong with your computer?
*
Broken screen
Battery doesn't last very long, or just stopped working
Input device not working (keyboard, mouse, webcam, microphone, touchscreen, etc.)
Gets uncomfortably hot
Doesn't turn on at all
Powers on, but never finishes booting up
Data loss
Crashes frequently
Runs very slowly
Network connectivity problems
Hard to explain, would prefer to just show the problem
Other:
What model is your computer?
*
Your answer
Enter your contact information below (Phone number and/or email address)
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report