Your Name

First Last

Vehicle (Year/Make/Model)

Address

Street Address City State ZIP Code

Cell Phone #

Email

Your Location*

While your vehicle is being serviced may we contact you by (check all that apply):

Call
Text
Email
Carrier Pigeon

Your driver’s side front window will be rolled down when the vehicle enters the shop. Please confirm that there is no known issue that might cause it to get stuck in the down position.

Window Functional

Yes, it functions normally
No, do not roll it down, it might not come back up.

Finding out what is important to you helps us to serve you better. A plan to address your vehicle that is tailored to your needs will save you both time and money. Please tell us more about how you view your vehicles.

Please tell us which statement best describes how you think about your vehicle:

My vehicle is just a means of conveyance that gets me where I need to go. If one gets too expensive to operate or too old, I’ll replace it.
I love my car. I generally keep my cars until the wheels fall off. It’s not uncommon for me to hold onto a car for 10 years or more.
I know it’s just a machine but this vehicle is very special to me, I have some wonderful memories associated with it and I will likely always keep it.

Is the vehicle you are bringing in for this visit

owned
leased

If you lease the vehicle, do you plan on buying it after the lease ends?

yes
no

Is this your

primary source of transportation
‘spare’ vehicle

What are your plans for this vehicle in the next year?

Have there been any significant maintenance or repairs done in the last 3 months?

yes
no

If yes, please provide details:

Do you currently follow the factory maintenance schedule?

yes
no

How many miles do you drive between oil services?

Why have you brought your car in today?

If your appointment is to address a problem (not simple maintenance), how often does the problem occur?

Constantly
Intermittently

Can you duplicate the concern?

yes
no

When did you first notice the issue?

Has the issue changed or gotten worse since you first noticed it?

yes
no

If yes, please explain:

Is there anything else you feel we should know prior to beginning work on your vehicle?

Consent*

I agree.*

I hereby authorize the repair work herein set forth to be done along with the necessary material and agree that you are not responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft or any other cause beyond your control. I hereby grant you and/or your employees permission to operate the vehicle herein described on streets, highways or elsewhere for the purpose of testing and/or Inspection. An express garage keeper’s lien is hereby acknowledged on the above vehicle to secure the amount of repairs thereto.

All vehicles left over 48 hours after repairs are completed WILL INCUR A $20.00 PER DAY STORAGE FEE.

Vehicle Intake Form

How Can We Help?We can’t wait to care for your car!