Diagnostic Questionnaire

Driveability Worksheet

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To provide a quick, complete and accurate diagnosis of your vehicle our technicians need a thorough description of the problem. Please take a few minute to complete this worksheet to the best of your ability. The information you provide will be a tremendous aid to the technician.

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Vehicle Information


Driveability Symptoms

Please check all symptoms that apply to your vehicle

My vehicle's "CHECK ENGINE" light

While operating the starter, my vehicle

When starting, my vehicle

While Idling, my vehicle

While driving, my vehicle

Other symptoms


Conditions of Occurrence

Time:

Speed:

Distance:

Conditions:

Frequency of Conditions

Environmental conditions

Engine Conditions

Driving Habits

Fuel Quality

Type of fuel used


Form 2.

Repair History

Please give the dates and mileage when your vehicle was last serviced or repaired You may want to ask for a copy of this Repair History for your personal repair records.


Service and Maintenance

Last Oil Change

Weight:

Was Oil Filter changed?

Last Tune Up

Components:

Other Services Performed

Minor Repairs

Air Conditioning

Equipment

Components Replaced:

Brakes

Parts Replaced:

Cooling System

Starting and Charging

Timing Belt Replacement

Reason:

Major Repairs

Engine

Transmission

Differential

Fuel, Ignition and Control Systems

Fuel System

Carburetor

Fuel Injected

Ignition System

Distributor

Computer Control System

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