Alignment Diagnosis

Customer Diagnostic Survey Form

First name*

Last name*

Email*

Vehicle Make & Model

License Number

VIN

Describe the speed at which the problem occurs (vehicle speed in MPH)*

Engine Speed*

If you selected "other", please describe.

The Problem Started*

Odometer Reading

Have the tires ever been balanced?*

Yes

No

Where any repairs performed prior to the condition occurring?*

Yes

No

Does the vehicle pull or drift?*

Yes

No

If yes, does it pull/drift Left or Right?

Left

Right

Please describe how the problem "feels". *

Does the vehicle exhibit any noises from the front end?*

Yes

No

** If you answered "Yes" to the above question, we ask that you also complete the "Noise & Water Leaks" Diagnostic Survey form.

Is the steering wheel off-center when the vehicle is going straight?*

Yes

No

Has the vehicle ever been in an accident?*

Yes

No

Describe any incident that may be related to the problem.

When was the vehicle's last alignment performed?*

The Problem Occurs*