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Engine Drivability
Customer Diagnostic Survey Form
First name
*
Last name
*
Email
*
Vehicle Make & Model
License Number
VIN
It Happens When...
When does the problem occur?
*
Light to Medium Acceleration
Hard Acceleration
Deceleration (foot off accelerator)
Cruising (constant highway speed)
Braking
Turning
Air Conditioning ON
Air Conditioning OFF
Hot Days
Cool / Cold Days
Humid / Rainy Days
Other
If you selected "other", please describe.
Outside Temperature
Please Select
Cold
Warm
Hot
Ambient Temperature? (Outside temp, in degrees)
Engine 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
What type of fuel is used?
*
Please Select
Regular
Mid-Grade
Premium
Alternative Fuel
Brand of Fuel
If you selected "Alternative Fuel" or "Brand of Fuel", please provide the fuel type or brand.
Define The Problem...
STARTING
Does the engine "crank"?
*
Yes
No
Does the engine start?
*
Yes
No
If yes, how long does it take the engine to start (in seconds)?
Does the engine stop immediately after starting?
*
Yes
No
Is the vehicle equipped with an alarm system?
*
Yes
No
Is the vehicle equipped with a remote starter system?
*
Yes
No
IDLE
Engine idles rough or unsteady?
*
Yes
No
Engine idles too fast?
*
Yes
No
PERFORMANCE
Describe the vehicle's engine performance problem(s). (Select all that apply)
*
Hesitates or stalls on acceleration
Stalls on deceleration or quick stops
Lacks power
Misses under load
"Pings" or "Knocks"
Runs on after key is turned off
Backfires (popping noise)
Speed changes without touching accelerator
Check engine light is on
Other
If you choose "other", please describe.
The Problem Occurs
*
Please Select
Rarely
Sometimes
Always
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