Refusion Client Intake Form
Hello there,
    Thanks for stopping by to fill out my form. Let me know what your needs are, and I will be in touch within the next 24-48 hours to see if I can fulfill your project needs. If I'm able to help, we can setup an initial consultation to meet in-person or over Google Meet. I currently reside in Arcata, California (Pacific Standard Time).

With kind regard,
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Email *
Name *
Business Name
Email *
Phone Number *
Best way to reach you? *
What service(s) are you interested in?
(Check All That Apply)
What is your dream outcome from working with me? *
Describe what you need: What resources, insights, guidance would help you fulfill your dream outcome? *
What steps have you already taken? What experiments have you embarked on? What samples have you already created? What insights have you picked up in the process? *
If you have a deadline, when is it?
Could be a soft deadline versus a hard deadline
A copy of your responses will be emailed to the address you provided.
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