Vehicle Questionnaire | Auto Tech Services

Questionnaire Received

We'll review your information before your appointment. Questions in the meantime? Call or text us at 573-378-7300.

Your Information & Vehicle

Full Name *

Phone / Text *

Best Way to Reach You

Year

Make

Model

Mileage

Appointment Date (if scheduled)

Any Warning Lights Currently On? (check all that apply)

Check Engine / SES ABS Traction Control / Trac Off Brake Battery Oil Pressure Airbag / SRS Check Gauges Tire Pressure / TPMS Temperature Warning None on Other (describe below)

What Are You Experiencing?

Noise Vibration Both

If There's a Noise — What Does It Sound Like? (check all that apply)

Knock Clunk Click / Tick Rattle Squeak Squeal Grinding / Scraping Hum / Drone Buzz Growl Thump / Bang Hiss

If There's a Vibration — Where Do You Feel It?

Steering wheel Seat Floor / floorboard Brake pedal Entire vehicle Engine area

Where Is It Coming From?

Front — driver side Front — passenger side Rear — driver side Rear — passenger side Under the hood Underneath the vehicle Inside the cabin Wheel / tire area

When Does It Happen?

At idle Accelerating Letting off gas Cruising Braking Turning Over bumps Going uphill Highway speeds All the time Intermittent

Does it change when turning?

Worse turning left Worse turning right No change

Does it change when braking?

Gets worse Gets better No change

Approximate speed it occurs (if speed-related)

Starts at approximately ___ mph

Smooths out above ___ mph (if applicable)

How Often & Under What Conditions

How often does it occur?

All the time Once a day A few times a week Occasionally Just started

Outside temperature when it occurs

Cold / below freezing Cool (32–50°F) Warm (50–75°F) Hot (75°F+) Humid or rainy Any temperature

When did you first notice it?

Describe it in your own words — the more detail, the better

What's the Problem? (check all that apply)

Overheating Runs hot but not overheating Coolant leaking Steam / smoke from engine Coolant light on Temperature gauge abnormal

Coolant Light & Temperature Gauge

Coolant warning light behavior

On steady Comes on and off Was on before, off now Has not come on

Temperature gauge reading

Higher than normal Normal Lower than normal

How long has the light been on or the gauge been abnormal?

When Does It Happen?

At idle / sitting still City / slow traffic Highway speeds Going uphill While towing or hauling All the time Intermittent

Conditions & History

Is the problem getting worse?

Yes No

Is the coolant level low?

Yes No Haven't checked

Was the AC running when it happened?

Yes No

Were you towing a trailer?

Yes No

Outside temperature when the problem occurs

Below freezing Cool (32–50°F) Warm (50–75°F) Hot (75°F+) Humid or rainy Any temperature

Any recent work done? Anything else we should know?

What's the Problem? (check all that apply)

AC not cooling Heater not heating Can't direct airflow to vents Airflow is weak Steams / fogs windshield Unusual noise from system Unusual smell from vents Temperature fluctuates unexpectedly

Air Conditioner

Is there any cooling at all?

Yes, some No, none

Did it stop suddenly or gradually?

Suddenly Gradually

How long since AC worked properly?

Heater

Is there any heat at all?

Yes, some No, none

Does the heater blow cool at stops?

Yes No

Airflow & Vents

Which outlets aren't working correctly?

Center dash vents Side vents Floor vents Defrost Rear vents All outlets

Noises & Smells

Any unusual noises from the HVAC system?

When compressor kicks on Increases with engine speed Changes when vent mode changes Squealing / rattling from vents

Any unusual smells?

Musty / mildew Sweet (coolant) Burning

Any recent work done? Anything else we should know?

Which Systems Are Affected? (check all that apply)

Battery / not starting Power windows Door locks Exterior lights Interior lights Instrument cluster Radio / infotainment Horn Windshield wipers Remote start Trailer lights Other (describe below)

Describe specifically what is or isn't working

Is the Problem Consistent or Intermittent?

All the time Comes and goes Only on cold start Only after warming up After rain / wet conditions

Outside temperature when the problem occurs

Cold / freezing Cool (32–50°F) Warm (50–75°F) Hot (75°F+) Any temperature

Vehicle History

Has the vehicle been in an accident recently?

Yes No

Has the battery been replaced recently?

Yes No

Have any fuses been replaced recently?

Yes No

Any aftermarket accessories installed? (remote start, alarm, audio, interlock, navigation)

Yes No

If yes, please list the aftermarket accessories

Any recent work done? Anything else we should know?

Which Fluid(s) Are You Losing? (check all that apply)

Engine oil Coolant / antifreeze Transmission fluid Brake fluid Power steering fluid Differential / axle fluid Fuel Not sure — something is dripping

Is It a Leak, Consumption, or Both?

Visible drip or puddle under vehicle Fluid disappearing — no visible drip Both — leaking & using more than normal Not sure

Engine Oil Consumption — Fill Out If You're Losing Oil

How often are you adding oil?

Every tank of gas or more often Every 500–1,000 miles Every 1,000–2,000 miles Every 2,000–3,000 miles Only at oil changes N/A

How much do you add each time?

Less than 1 quart About 1 quart More than 1 quart N/A

Oil pressure warning light

On steady Flickers occasionally Not on

Visible Leak — Location & Appearance

Where is the fluid showing up on the ground?

Front of vehicle Center — engine / transmission Rear of vehicle Driver side Passenger side Hard to tell

What color is the fluid on the ground?

Black or dark brown Reddish or pink Bright green / orange / yellow Clear or light yellow Dark amber or brown Rainbow sheen on pavement

How severe is the visible leak?

Just a few drops after sitting Small puddle after sitting overnight Large puddle after sitting Actively dripping while running N/A — no visible drip

Smoke & Smell

Blue or gray smoke from the exhaust (indicates burning oil)

Yes No Occasionally

White smoke or steam from the exhaust (indicates coolant or condensation)

Yes No Occasionally

Smoke or steam coming from under the hood

Yes No Occasionally

Burning oil smell

Yes No Sometimes

Sweet or syrupy smell (indicates coolant)

Yes No Sometimes

Fuel smell inside the cabin or outside the vehicle

Yes No Sometimes

History & Details

Is the problem getting worse over time?

Yes No Not sure

Is the fluid loss worse after the engine warms up?

Yes No Not sure

How long has this been going on?

Any recent repairs, fluid changes, or work done on the vehicle?

Describe it in your own words — the more detail, the better

What Are You Experiencing? (check all that apply)

Hard to start — cold Hard to start — warm / hot Won't start at all Rough idle / shaking Stalling at idle Stalling while driving Hesitation / stumble when accelerating Engine surging / RPMs hunting Misfiring / bucking / jerking Loss of power Poor fuel economy Backfire / popping

Starting — Fill Out If You're Having Trouble Starting

What happens when you turn the key or push the button?

Cranks normally but won't fire Cranks slowly / sounds weak Just clicks — won't crank Nothing — completely dead N/A

When is it hard to start?

Cold engine only Warm / hot engine only Both cold and warm Always hard to start N/A

How long does it crank before starting?

1–2 seconds 3–5 seconds More than 5 seconds Sometimes won't start at all N/A

Does holding the gas pedal down while cranking help it start?

Yes No Haven't tried

Idle Quality

How would you describe the idle?

Rough / shaking RPMs surging up and down Very low — almost stalls Unusually high idle Stalls at idle Idle is fine — problem only while driving

Does the idle smooth out after the engine fully warms up?

Yes No Gets worse when warm Not sure

Does the rough idle or stalling happen more when in gear vs. in Park / Neutral?

Worse in gear Same either way N/A

Acceleration & Under Load

When does the hesitation, stumble, or misfire occur?

Just off idle — first press of gas Light acceleration / steady cruise Mid-range acceleration Hard acceleration / wide open throttle Merging onto highway Going uphill / under load At highway cruise speed Any time / doesn't matter

Does it feel like the engine cuts out or falls on its face momentarily?

Yes No

Does it feel like the engine is misfiring — bucking or jerking unevenly?

Yes No Sometimes

Does it feel like the transmission is slipping or not shifting correctly?

Yes No Not sure

Check Engine Light & Codes

Check engine / Service Engine Soon light status

On steady Flashing / blinking Was on — now off Not on

Has the vehicle been scanned for diagnostic codes?

Yes No

If scanned — what codes came up? (e.g. P0300, P0171)

Smoke, Smell & Conditions

Any smoke from the exhaust?

Black smoke Blue / gray smoke White smoke / steam No smoke

Any unusual smells?

Rotten egg / sulfur Raw fuel smell Burning smell Sweet / coolant smell

Outside temperature when the problem occurs

Cold / below freezing Cool (32–50°F) Warm (50–75°F) Hot (75°F+) Any temperature

How long has this been going on?

Any recent repairs or maintenance? What fuel grade do you use?

Describe it in your own words — the more detail, the better

We'll review this before your appointment and follow up if we have questions.