Sherwood Auto Repair Step 1 of 9 11% Name(Required) First Last Address Street Address City State / Province / Region ZIP / Postal Code Cell Phone(Required)Email Birthday (Mth/Day)How Did You Hear About Us?VEHICLE INFORMATIONPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Year(Required)Make(Required)Model(Required)How Long Have You Owned The Vehicle?What Is The Vehicle Primarily Used For?How Long Do You Hope To Own/Drive The Vehicle?Vehicle Concern 1 Oil Service (3k/5k/7.5k) Brakes Check Engine Light Overheating Squeeks, Rattles and Vibrations Vehicle Concern 2 Check Heat / A.C ABS Light On Suspension / Steering Transmission Issue Electrical Issue Vehicle Concern 3 Check For Oil Leaks Transmission Service Alignment Cooling System Service Stalls At Stops No Issues I am happy to report that there are no concerns with my vehicle at this time! Describe The Concern With The VehicleDid Anything Happen to The Vehicle Prior to The Symptom? PRE-VISIT QUESTIONNAIRE: COOLING SYSTEM / OVERHEATINGPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Which best describes the issue: Overheating Not Warm Enough Coolant Leaking Steam From Under The Hood Coolant Light Goes On / Off Coolant Light On Check Engine Light Is On Temperature Light Is On Temperature Gauge is Not Warm Enough Coolant Leaking Steam From Under The Hood OtherWhen does this occur: Always Sometimes (Once of Twice A Week) Rarely (Once or Twice A Month) Just Started Has Happened Since The Car Was New Highway Speeds Slow Traffic Pulling A Trailer OtherHeating and A/C Settings A/C Was On Heater Was On A/C and Heater Was Off The Outside Temperature Was: Cold Warm Hot Humid or Raining Other, Please DescribeHow Long Has The Problem Occurred? Just Started Once A Week Once A Month Since The Car Was New Have There Been Other Attempts by Another Shop to Correct The Problem?NoYes PRE-VISIT QUESTIONNAIRE: CHECK ENGINE LIGHT/DRIVABILITYPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Please Select One: Check Engine Light is On Check Engine Light Was On in The Past Month Check Engine Light Goes On and Off Which best describes the issue: Hard Starting Engine Cranks But Does Not Start No Crank Idle is Rough Idle is High Idle Fluctuates Engine Hesitates or Stumbles Engine Backfires or Makes Popping Noise Engine Misfires or Skips Poor MPG No Symptoms MPG BeforeMPG NowOther (please describe):When Was The Last Service Performed On The Car?Has The Check Engine Light Been on Before?NoYesIf So, When?When does this occur: Always Sometimes (Once or Twice A Week) Rarely (Once or Twice A Month) Just Started Has Happened Since The Car Was New Engine Temperature: Cold While Warming Up Normal Operating Temperature Hot All of The Above The Outside Temperature Was: Cold Warm Hot Humid Other (Please Describe)Driving Conditions: Accelerating Hard Medium Light Decelerating Cruising Cornering Have There Been Other Attempts by Another Shop to Correct The Problem?NoYes PRE-VISIT QUESTIONNAIRE: ELECTRICALPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Which best describes the issue (what electrical component is being affected?) Add RemoveHave Any Fuses Been Replaced Lately?NoYesHas Your Vehicle Been In An Accident?NoYesIf So, What Part Was Damaged?Have There Been Any Electical Repairs Done in The Last Month?NoYesIf So What Was Repaired?Was The Battery Replaced Recently?NoYesWhen does this occur? At Idle Light Acceleration Medium Acceleration Heavy Acceleration MPHThe Problem Happens: All The Time Once A Day Once A Week Once A Month The Engine Was Cold Hot Normal Operating Temperature The Outside Temperature Was: Cold Warm Hot Sunny Dry Raining Other (Please Describe) When Did The Problem Occur Last? MM slash DD slash YYYY Other (Please Describe)Was The A/C On?NoYesWas The Vehicle Towed In?NoYesHave There Been Other Attempts by Another Shop to Correct The Problem?NoYes PRE-VISIT QUESTIONNAIRE: HEATING & A/CPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Which best describes the issue- Air Conditioning:NoYesIs There Any Cooling Effect?If Yes, How Long Does it Take to Cool The Vehicle?Minutes / Miles (Please Indicate)How Many Days Since The Air Conditioning Was Last Operated?DaysAir Conditioning Noise Occurs when A/C is On Air Temperature Fluctuates Back & Forth Only Works On Certain Settings No Air Coming From Vents Is There Any Heating Effect?NoYesIf Yes, How Long Does it Take to Warm The Vehicle?Minutes/Miles (Please Indicate)Airflow Cannot Be Changed to Different Outlets. Which Outlets Do Not Work? Center Left (Driver) Side Right (Passenger) Side Floor Defrost Air Intake Cannot Be Changed Which Does Not Work? Fresh Air (Outside) Recirculating Air Unusual Noises?NoYesThe Problem Started Suddenly Gradually Just Started The Problem Occurs Rarely Sometimes Always Have There Been Other Attempts by Another Shop to Correct The Problem?NoYes PRE-VISIT QUESTIONNAIRE: NOISE & VIBRATIONPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Type of Noise Buzz Chatter Chirp Clunk Grind Hiss Hum Knock Rattle Squeal Tap Roar Rumble Squeak Whistle Whine OtherDoes Your Vehicle Make The Noise When Turning in either direction while moving?: Left Right Both Does Your Vehicle Make the Noise When You Were Braking?YesNoDoes Your Vehicle Make The Noise When The A/C or Heat was..OnOffDoes Your Vehicle Make The Noise When The Vehicle is Parked or Idling?YesNoOtherHow Fast Were You Traveling When The Noise Occurred? (MPH)What Was The Weather Like? (Ex: Heavy Rain)Have There Been Other Attempts by Another Shop to Correct The Problem?NoYesWhen Does This Occur? PRE-VISIT QUESTIONNAIRE: AUTOMATIC TRANSMISSIONPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Which best describes the issue: Transmission/Transaxle Does Not Shift Properly Slow, Mushy, or Early Shift Rough, Harsh, or Delayed Shift Slippage (Engine Speed Increases at Initial Takeoff or When Shifting) No Up Shift No Down Shift Will Not Shift At All Engine Starts in Positions Other Than “P” or “N” Unusual Noises Please Describe:The Problem Occurs:RarelySometimesAlwaysAny Warning Lights On?YesNoCheck Engine Light On:YesNoWhen does this occur - Gear Selector (When Gear Level Is In): P R N O D D 1 2 Between Gear Positions: 1 & 2 2 & 3 3 & 4 (Overdrive) Driving Conditions: Accelerating Decelerating Braking Low RPM Medium RPM High RPM Engine Temperature:ColdNormalHotTransmission Temperature:ColdNormalOutside Temperature:ColdAverageHotThe Problem Started: Suddenly Gradually Just Started Since The Vehicle Was New Have There Been Other Attempts by Another Shop to Correct The Problem?NoYes PRE-VISIT QUESTIONNAIRE: BRAKE SYSTEMPLEASE CHECK ALL APPLICABLE BOXES AND FULLY DESCRIBE THE CONDITION THAT APPLIES TO YOUR VEHICLE.Does The Car Stop Okay?The Brake Pedal Seems Okay Soft Hard Spongy Too Low Too High Goes To The Floor To Vibrates / Pulsates To Work Better When Pumped To Return To Slowly When Pressing The Brake Pedal: Steering Wheel Shakes Vehicle Shakes The Pedal Vibrates/Pulsates Does the Vehicle: Stop Straight Always Pull in One Direction Pulls Left Only When Braking Pulls Right Only When Braking What Noises Can Be Heard: Grinding While Braking Rotational Scraping At All Times Squeaking Only When Braking The Emergency Brake: Is Seldom Used Works Ok Does Not Work Properly Additional DescriptionIs Dash Brake Light On?Has There Been Any Recent Brake Work Done?Any Other Symptoms?Any Other Comments or Concerns?Have There Been Other Attempts by Another Shop to Correct The Problem?NoYesAdditional InformationAny Additional Information? Date(Required) MM slash DD slash YYYY Would You Like To Pre-Authorize Repairs? Yes No Pre-Authorization Amount$1000$1500$2000SignatureEmailThis field is for validation purposes and should be left unchanged.
