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Client Noise Concern Questionnaire
Please answer all of the questions to better give us an understanding of the noise you are hearing.
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Email
*
Your email
Customer Information: Please include name, email, phone number, as well as year, make, model, mileage and license plate of vehicle.
*
Your answer
When is the concern occuring?
Always
Sometimes
Rarely
Other:
What kind of noise are the brakes making?
Squaking
Squealing
Grinding
Rubbing
No Noise
Other:
How does the brake pedal feel?
Too soft
Too hard
Goes to the floor
Shudders under load
shudders at high speed *Pleae put approximate speed under other*
Pulsation
Other:
Are the dash warning lights on?
Brake Light
ABS Light
Other:
When does the concern occur?
Slowing to brake
Hard/sudden braking
Releasing the brake
Turning & Braking
In the morning/first drive of the day
Other:
What is the outside weather like when the concern occurs?
Cold
Warm
Hot
Wet
Dry
Other:
When approximately did the concern Started?
MM
/
DD
/
YYYY
Any other information you can leave us that might assist in diagnosing your vehicle.
Your answer
Have you already booked an appointment? If not please feel free to use our online booking system
Butterworth's Online Booking System
Your answer
A copy of your responses will be emailed to the address you provided.
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