IF YOU ARE FACING A CHARGE FOR DUI/DWI/DRUNK DRIVING, YOU CAN RECEIVE A FREE EVALUATION OF YOUR CASE BY COMPLETING THE FOLLOWING CONFIDENTIAL QUESTIONNAIRE, OR BY SIMPLY CALLING US TOLL-FREE AT:
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| *Phone: |
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| Date of Arrest: |
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| Time of Arrest: |
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| City of Arrest: |
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| County of Arrest: |
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| State of Arrest: |
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| Ask a Question: |
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If you simply want to ask a question, you can do so now and click here to jump to the bottom of the form and submit. However, we strongly encourage you to complete the ENTIRE form, even if you are asking only a question, so that the attorney can give you the best advice possible.
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| Court Date: |
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| Time of Court: |
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| Was there a breath test taken on the scene? |
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| Result: |
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| Was there a breath test at the police station? |
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| Was there a blood and/or urine test taken? |
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| Result: |
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| Is this your first arrest for DUI/DWI/Drunk Driving in your lifetime-anywhere? |
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| Please list all prior DUI/DWI/Drunk Driving Arrests (even if dismissed) below, including year, city/state, and outcome (if known): |
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| Are you currently on probation/parole for any DUI or criminal case? |
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| If "yes", for what offense(s): |
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| Why were you stopped according to the police officer? |
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| Was there an accident? |
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| Was anyone injured? (Check all that apply): |
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No one was hurt
Myself
Passenger in my vehicle
Passenger in another vehicle
Pedestrian
Not_Sure
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| Were you given field sobriety tests at the scene, hospital or police station? |
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| Did any police tell you that the tests were optional (you could refuse)? |
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| Do you want to challenge the possible suspension of your drivers license? |
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| Do you need driving privileges for (check all that apply): |
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Work
School
Medical care
Transporting your children
Personal errands
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| Did you ever tell the police that you wanted to speak to an attorney? |
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| Did you ever ask for an independent test of your own? |
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| Is it possible that there was drugs/medications in your system? |
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| Are there any witnesses who were with you before or during your driving that can testify for you? |
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Additional Comments:
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IF YOU ARE FACING A CHARGE FOR DUI/DWI/DRUNK DRIVING, YOU CAN RECEIVE A FREE EVALUATION OF YOUR CASE BY COMPLETING THE ABOVE CONFIDENTIAL QUESTIONNAIRE, OR BY SIMPLY CALLING US TOLL-FREE AT:
1-800-DIAL-DUI
1-800-DIAL-DWI |
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The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent. |
