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Automatic Transmission
Customer Diagnostic Survey Form
First name
*
Last name
*
Email
*
Vehicle Make & Model
License Number
VIN
It Happens When...
GEAR SELECTOR
Describe the position of the gear selector (select all that apply)
*
P (Park)
R (Reverse)
N (Neutral)
D (Drive 1-10 gear)
D (Drive 1-2 gear)
D1 (Drive 1st gear only)
Between what gear position(s) does the problem occur? (Select all that apply)
1 and 2
2 and 3
3 to 10
The Problem Occurs When
*
Light to Medium Acceleration
Hard Acceleration
Deceleration (foot off accelerator)
Braking
2 WD on
4 WD on
Engine Speed
Please Select
Idle
Medium
High
Engine Speed (RPM)
Engine Temperature
Please Select
Cold
Warm
Hot
Outside Temperature
Please Select
Cold
Warm
Hot
The Problem Began Occurring
*
Please Select
Suddenly at ____ (odometer reading)
Gradually at ____ (odometer reading)
Just started ____ (odometer reading)
Since the vehicle was new
Odometer Reading
Has the transmission been previously repaired?
*
Yes
No
Define The Problem...
TRANSMISSION
Does the transmission/transaxle shift properly?
*
Yes
No
Describe how the problem "feels". (Select all that apply)
*
Slow, mushy, or early shift
Rough, harsh, or delayed shift
Slippage (engine speed increases at initial takeoff or when shifting)
No upshift
No downshift
Will not shift at all
Does the engine start when the selector lever is not in "P" (park) or "N" (neutral)?
*
Yes
No
The Problem Occurs
*
Please Select
Rarely
Sometimes
Always
UNUSUAL NOISES
Are there any unusual noises?
*
Yes
No
If yes, please describe the noise and where it seems to be coming from.
SPEED OF VEHICLE
Describe the speed at which the problem occurs (vehicle speed in MPH)
Is the vehicle used for towing?
*
Yes
No
If yes, what is the size or weight of the trailer?
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