Auto Rx

Contact Information

First Name (required):

Last Name (required):

Phone (required):

Email (required):

I prefer to be contacted by

Phone

Text

Email

Appointment Date and Time Requested

Appointment Date (required):

Appointment Time (required):

Alternate Transportation

I need transportation assistance (Not all facilities may offer alternate transportation. Please confirm availability directly with repair facility.)

Vehicle Information

Year (required):

Make (required):

Model (required):

Mileage

VIN

Service(s) Desired

Oil change

Factory recommended maintenance

Fluid replacement

(if other than oil, describe in notes box)

Repair service

(please provide details in the notes box)

Diagnostic service

(please provide details in the notes box)

Additional Information

Notes

Search For AAA Approved Auto Repair Facilities