Performance and Intermittent problems
GENERAL INFORMATION Questionnaire
(Please note: This form is designed for use by Automotive Advantage customers
who can bring their vehicle into our shop for further diagnosis and repair.)
Intermittent problems can be a very frustrating experience for both the customer and the technician. In order to serve you
better, please fill out the information below, and check off the appropriate boxes. If necessary, keep this form with you for a
few days so the information needed will be fresh in your mind the next time the problem occurs.
Our Privacy Promise: Any information you provide to us will be used solely in the course of diagnosing and repairing your
vehicle. We will protect your information from unauthorized use, and will never share it with outside parties.
Did it make any difference?
Yes
No
Does the car have problem
when the engine is:
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Does the car have problems when weather conditions are:
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How often does this problem occur?
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What is the longest period of time, in normal use, during which you did not notice the problem:
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Other helpful information (check ALL that are appropriate)
Brand of Fuel Used:
Octane:
Regular
Midgrade
Premium
Any recent changes of gas brand?
Any unusual raw gas smells?
Has vehicle been sitting for a long time?
If so, how long?
Is vehicle normally garaged?
Is vehicle only driven on short trips?
Approximate miles per day:
Has vehicle ever been in an accident?
What area(s) of the vehicle were damaged?
Has vehicle
been stolen/recovered recently?
Has vehicle just been washed?
Have you ever noticed wet carpeting?
Does vehicle have a salvage title?
Has the vehicle just had body work or other repairs?
Has a stereo or other accessory been recently installed?
Does the vehicle's radio have static?
Did the problem happen shortly after gas purchase?
Did the problem occur right after loaning the car to someone else?
Has anyone else experienced this problem with your vehicle?
Does altitude seem to have any effect?
Does the temperature gauge ever show overheat?
Does the temperature gauge show very low temperature, even after driving
for 20-30 minutes?
Does the heater take a long time to put out hot air?
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