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Fluid Leak — Client Questionnaire

Thank You For Choosing Gearhead Automotive! Leaks Are Much Easier To Trace With A Few Details Up Front. The More You Can Tell Us — And A Photo If You Have One — The Faster Our Technician Can Find The Source And The Less It Costs You. Please Fill This Out Before Your Appointment.

About You And Your Vehicle

What Is Your Name?

Best Phone Number

Email Address

Vehicle

Approximate Kilometers

Are You The Primary Driver Of This Vehicle?

A
B

Identify The Fluid

In Your Own Words, Describe The Leak

A Photo Of The Leak — Or Of The Puddle Where You Park — Helps Our Technician Enormously. Upload One Below If You Can.

Upload A Photo Of The Leak Or Puddle (Optional)

What Type Of Fluid Do You Think Is Leaking? (Check All That Apply)

A
B
C
D
E
F
G
H
If You're Not Sure, That's Fine — The Color Question Below Helps Us Narrow It Down.

What Color Is The Fluid? (Check All That Apply)

A
B
C
D
E
F
G
H

Does The Fluid Have A Noticeable Smell?

A
B
C
D
E

How Much Fluid Are You Seeing?

A
B
C
D
E

Where And When

Answer What Applies - Skip Anything That Doesn't Relate To Your Concern(s)

Where Does The Leak Appear Or Where Do You Find The Fluid? (Check All That Apply)

A
B
C
D
E
F
G
H

Describe Where The Leak Seems To Come From In Your Own Words (Optional)

When Do You Notice The Leak? (Check All That Apply)

A
B
C
D
E
F
G
H
I

What Is The Engine Temperature When The Leak Is Most Noticeable?

A
B
C
D

How Often Does The Leak Occur?

A
B
C
D

Fluid Levels, Warnings & History

Have You Had To Add Fluid To Keep The Vehicle Running Normally?

A
B
C
D

Have Any Warning Lights Come On Related To This Leak?

A
B
C

When Did You First Notice The Leak?

A
B
C
D
E
F

Any Additional Details About When It Started (Optional)

Were Any Repairs Or Changes Made Around The Time This Leak Started?

A
B
C

Has This Vehicle Been To Another Shop Or Place For This Same Leak?

A
B
C
D

Is There Anything Else You'd Like Our Technician To Know About The Leak?