Boulevard Auto Repair
  Fill out this form to make an appointment. If you need service today or tomorrow, please call (818) 989-6028 to schedule.
Brakes Appointment:
* Denotes Required field
Name * Phone *
Email Please call me at:*
Vehicle Info:  
 
Year* Model* Mileage
 
Please explain the problem you are having:
 
To expedite the drop off of your vehicle, please fill out this brief questionnaire and help to diagnose your vehicles problem. Please check all that apply to your vehicle:

Brake Symptoms
 
Does your car stop OK?:
Yes

 No Sometimes
 
The brake pedal seems:
To work OK Too High To pulsate or chatter
Hard Too low To work better when pumped
Soft Spongy Returns to slowly
 
Does the vehicle:
Stop straight Pull left when braking
Pulls in one direction Pull right when braking
 
Do the brakes:
Grab Seem to be dragging Lock at times
Make noise
 
Emergency/Park brake:
Is seldom used Works OK Doesn't work properly
Explain:
 
Added brake fluid in past 6 months?
Yes No  
Have brakes been flushed and bled in last 6 months?
Yes No
Adjusted?
Yes No

Is brake light on?
Yes No    

Last time brakes were serviced and/or repaired:
3 mos 6 mos
9 mos Longer


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