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Subject:


1. Does your car stop OK?
--Select-- Yes No Sometimes

2. The brake pedal seems:
--Select-- To work OK Hard Soft Too high Too low Spongy To pulsate or chatter To work better when pumped To return too slowly

3. Does the vehicle:
--Select-- Stop straight Always pull in one direction Pull left only when braking Pull right only when braking

4. Do the brakes:
--Select-- Grab Lock at time Seem to be dragging Make noise

5. The Emergency/Parking brake:
--Select-- Is seldom used Works OK Doesn't work properly. Explain below.

Explain:


6. Have the brakes been flushed in the last 6 months?
--Select-- Yes No

7. Have the brakes been adjusted in the last 6 months?
--Select-- Yes No

8. Is dash brake light on?
--Select-- Yes No

9. Last time brakes were serviced or repaired:
--Select-- 3 Months 6 Months 1 Year Longer