Engine Drivability Customer Diagnostic Survey

Allow us to expedite the repair of your vehicle in a more timely manner:

Engine Drivability
Customer Diagnostic Survey Form
* Customer Name:
* Date:
R/O#
* Year:
*Make:
* Model:
* LIC#
The Concern Occurs

(All That Applies)

*AlwaysSometimesRarely
* Check Engine Light:OnOff

Driving Performance
Engine idles rough/unsteadyEngine idles too fastHesitatesStallsLacks PowerMisfiresPings or KnocksRuns on after key is turned offBackfires (popping noise)Speed changes without touching accelerator

Fuel Mileage Changed:
Other:
When the concern occurs *
Light to medium accelerationHard accelerationDecelerating (Foot off accelerator)Cruising (constant or highway speed)Braking slowlyBraking suddenlyTurning

Other:
Air Conditioning
OnOff
Engine Temperature:
ColdWarmHot
Outside Temperature:
ColdModerateHotWetDry
Concern Started

(All That Applies)


(date/ODO)
Since the vehicle was newSince the vehicle was serviced lastImmediately after fueling

Type of Fuel Used *
RegularMid gradePremium
Brand of Fuel:
Date Filled up:
Driving Habits
Are the principal driver?YesNo
Drive hard before engine warm? YesNo
Allow the engine to warm Mins
Vehicle Parked:InsideOutside
Driving:CityHighway
Drive less than 15km or 15 mins/dayDrive 15-18km or 15-60 mins/dayDrive more than 80km or 1hr/day
Additional Comments

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