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Power Train Symptoms Client Concern Questionnaire
Please answer all of the questions to give us a better understanding of the power train issues you are having.
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Email
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Your email
Customer Information: Please include name, email, phone number, as well as year, make, model, mileage and license plate of vehicle.
*
Your answer
How often does the concern occur?
Always
Sometimes
Rarely
Other:
Is the Check Engine Light On?
Yes
No
Other:
Clear selection
Driving Performance
Engine idles rough/unsteady
Engine idles too fast
Hesitates
Stalls
Lacks power
Misfires
"Pings" or "knocks"
Runs on after key is turned off
Backfires (popping noise)
Speed changes without touching accelerator
Fuel Mileage recently changed
Other:
When does the concern occur?
Light to medium acceleration
Hard acceleration
Decelerating (foot off accelerator)
Braking slowly
Braking suddenly
Turning
Other:
Is the Air conditioning on when the concern occurs?
Yes
No
Other:
Clear selection
What is the Engine temperature when the concern occurs?
Cold
Warm
Hot
Other:
What is the temperature outside when the concern occurs?
Cold
Moderate
Hot
Wet
Dry
Other:
Approximately when did the concern start? Date and Odometer Reading
Your answer
How did the concern start?
Started suddenly
Started gradually
Immediately after fueling
Other:
What type of fuel is used?
Regular
Mid Grade
Premium
Clear selection
What brand of fuel is purchased and what is the date of the last fill up.
Your answer
Are you the principal driver?
Yes
No
Other:
Clear selection
What are the driving habits of the vehicle?
Drive hard before the engine is warm
Allow engine to warm up
Other:
Where is the vehicle stored?
Inside
Outside
Other:
Clear selection
What are the distant driving habits? (check all that apply)
City driving
Highway driving
Drive less than 15km ir 15 mins/day
Drive 15-18 km or 15-60 mins/day
Drive more than 80km or 1 hr/day
Other:
Does this vehicle have a security system?
Yes
No
OEM
Aftermarket
Other:
Has this vehicle been to another repair facility for the same concern?
Yes - If yes, please describe details in other
No
Other:
Has this veihicle had software modifications? Has it been chipped or tuned?
Yes
No
Other:
Clear selection
Any other information you leave us that might assist in diagnopsing your vehicle.
Your answer
Have you already book an appointment? If not please feel free to use our online booking system at
Butterworth's Online Booking System
Option 1
Clear selection
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