Check Engine Light / Drivability Questionnaire

Finding out what is not working right is the hardest part. A check engine light is a warning that a particular part or a particular vehicle system is not working as designed. A prolonged malfunction situation can lead to costly repairs. We would encourage you to answer the questions below to give us a little more insight as to how and when the conditions occur. By taking the time to answer now, you may help shorten the repair process time. Your information is critical in assisting us during the diagnostic process. Thank you.

Personal Information

First Name *

Last Name *

Email Address *

Is This Your First Time Visiting With Us?

Yes

No

Thank you. Any change in address for you?

Yes

No

Are You The Primary Driver?

Yes

No

Preferred Method Of Contact *

Cell Phone

Home Phone

Work Phone

Email

Number To Call *

Additional Contact Number

May We Update Your Repair Status Via Text?

Yes	No Thank You

How Did You Learn About Us?

Referrals First Name

Referrals Last Name

Current Address

Your Current Street Address

Address Line 2

City

State *

Zip Code

Your Vehicle Information

YEAR

MAKE

MODEL

CURRENT MILEAGE

Do You Have Wheel Locks Installed?

Yes

No

Can You Tell Us Where The Wheel Lock Key Is Located?

Prior Vehicle History (Briefly Tell Us Of Any Past Repairs)

0/5000 characters

Please Describe Your Vehicle Concerns

Please Select The Best Answer To These Questions

	Yes	No
Is The Check Engine Light On?	Yes	No
Did It Just Come On?	Yes	No
Has The Light Been Reset	Yes	No
Is The Check Engine Light Flashing?	Yes	No
Is The Vehicle Running Rough?	Yes	No
Are You Smelling Any Harsh Odors?	Yes	No
Do You Hear Any Abnormal Engine Noises? (Rattles, etc)	Yes	No
Is The Engine Ever Hard To Start?	Yes	No
Any Other Warning Lamps On?	Yes	No
Do You Notice Any Fluid Leaks?	Yes	No
Has This Problem Been Repaired Before?	Yes	No

What Is The Outside Temperature Like While Driving?

Below Freezing

Cold (32F/50F)

Warm (51F/80F)

Hot (80F+)

What Speed Are You Driving?

	0-25 MPH	26-50 MPH	51-65 MPH	66-85 MPH	+85 MPH
-	0-25 MPH	26-50 MPH	51-65 MPH	66-85 MPH	+85 MPH

Describe How You Are Driving

What Are The Road Conditions When The Problem Occurs?

DESCRIBE YOUR CONCERNS HERE:

File Upload Section

In this section, you can upload any additional files such as old repair tickets (not by us), pictures of fluid leaks, damage areas and you can upload an audio recording of the problem. The more information we receive the better.

Older Repair Tickets (not performed by us)

Pictures

Audio Recordings

Other Services Available On Your Visit

May We Help You With Other Services During Your Visit? (Check all that apply)

Add Comments: What Else Have You Noticed About Your Vehicle Since Your Last Service?

Arrival Time (After hour drop off can use our secure key drop)

	Early AM	Mid Morning	Mid-Day	After Hours
Drop Off Time	Early AM	Mid Morning	Mid-Day	After Hours

Do You Require A Shuttle?

Yes

No

To Where?

Work

School

Home

PLEASE SIGN: All repairs are warrantied nationwide for a period of 3 years or 36,000 miles with the NAPA Nationwide Warranty. Some exceptions exists with speciality parts and conditions. We will provide you with complete estimates prior to performing your selected services. Please electronically sign below. *

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It's In Park	I'm Driving Steadily	I'm Accelerating
I'm Coming To A Stop	It Could Be Anytime	Other Other

Oil Change Service	Routine Maintenance	Alignment
Battery	Tire Pressure And Condition	Tire Rotation
Belts And Hoses	Wiper Blades	Wheel Balance
All Fluids	Cooling System	Transmission Fluid Service
A/C System Service	Check Shocks & Struts	Check Stop Lights & Headlamps