Air Conditioning Questionnaire

Please take a moment to complete our pre-appointment Air Conditioning Questionnaire. The questions below offer us insight to your symptoms, your driving habits and any previous repairs. They are used to help us locate and repair your vehicle's concerns, saving you time and money.

Personal Information

First Name *

Last Name *

Email Address *

Is This Your First Time Visiting With Us?

Yes

No

Are You The Primary Driver?

Yes

No

Thank you. Any change in address?

Yes

No

Preferred Method Of Contact *

Cell Phone

Home Phone

Work Phone

Email

Number To Call *

Additional 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

Vehicle Information

Vehicle Year

Vehicle Make

Vehicle Model

Current Mileage (approximate)

How Long have You Owned This Vehicle?

Since New	3-11 Months
1-3 Years	3 + Years

Do You Have Wheel Locks Installed?

Yes

No

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

Is This Vehicle Used For Commercial Purposes?

Yes

No

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

0/255 characters

Vehicle History

Do Any Of These Pertain To You Recently?

Accident	Entertainment System Replacement
Alarm System Install	Past Heating Or Air Conditioning Repairs
Vehicle Modifications / Conversions	Major Mechanical Repairs
No. None Of These Apply To Me	If so, please explain... If so, please explain...

Vehicle A/C Symptoms

Does The A/C System Keep You Cool Enough?

Yes

No

Describe Your Condition

It's Cold, Then Hot	Not Enough Air Flow
It's Just Not Cold Enough	It's Always Hot

Please Select The Best Answer To These Questions

	Yes	No	Not Sure
Do You Have Dual Zone Air?	Yes	No	Not Sure
Do All Vents Blow Cold Air?	Yes	No	Not Sure
Do All Vents Work Properly?	Yes	No	Not Sure
Does The A/C System Turn On?	Yes	No	Not Sure
Does The Rear System Turn On?	Yes	No	Not Sure
Do You Hear The Fan/Blower Working?	Yes	No	Not Sure
Is The A/C Noisy When Turned On?	Yes	No	Not Sure
Are There Dash Noises When Changing The Controls?	Yes	No	Not Sure
Does The Car Stall When You Turn A/C On?	Yes	No	Not Sure
Does The Car Idle Funny When You Turn On A/C?	Yes	No	Not Sure
Does Your Car Overheat When You Turn On A/C?	Yes	No	Not Sure
Do You Smell Musty Or Foul Odors Inside The Vehicle?	Yes	No	Not Sure

When Was The Last Time The A/C System Was Serviced?

Please Describe To Us Any Special Requests, Instructions Or Other Vehicle Concerns

Other Services And Coupons Available

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?

What Time Will You Arrive?(After hour drop off can use our secure key drop)

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

Do You Require Shuttle Service?

Yes

No

To Where?

Work

School

Home

Please click the SUBMIT BUTTON below to send us your information.

Never	3-6 Months	6-12 Months
1-3 Yrs.	+3 Yrs.	Don't Know

Oil Change Service	Scheduled 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