DUI Accidents

Please take a minute and fill out this evaluation form. This will allow us to review the details of your case and get back to you with important information. This is a free and confidential service with no obligations.

Fields marked with * are required.

* Name:
* Phone: Format: xxx-xxx-xxxx
* Email:
Driver's License Number:
Date of Birth:
Date of Arrest:
Time of Arrest:
Court Where You Are To Appear:
Date You Are Scheduled To Appear:
City Where Arrested:
Which law enforcement agency arrested you? (Example: Highway Patrol, City Police Department)
Is this your first DUI?	Yes No
If you have had prior DUI's, please list dates and court and results:
Are you currently on probation or parole?	Yes No
If yes, for what offense and in what state, city and county?
Have you requested your DMV hearing?	Yes No
Did the officer observe you driving a vehicle?	Yes No
Did you admit to driving the vehicle?	Yes No
Was there an accident?	Yes No
If so, were there any injuries as a result of that accident?	Yes No
Were you stopped at a road block?	Yes No
Were you under 21 years of age at the time of the arrest?	Yes No
Was there a child under 14 years of age in the vehicle at the time of arrest?	Yes No
If you were on surface streets, were you speeding 20 MPH or more beyond the posted speed limit?	Yes No
If you were on the freeway, were you speeding 30 MPH or more beyond the posted speed limit?	Yes No
Did you tell the officer you had been drinking?	Yes No
If so, how much did you tell the officer you had been drinking?
What time did you tell the officer that you had your last drink?
Did you perform any Field Sobriety Tests?	Yes No
Did the officer ask you to blow into a handheld breath device at the scene?	Yes No
If so, did the officer advise you that you had a right to refuse that on-scene breath test?	Yes No
How many times did you blow into the breath device?
At your arrest, were you advised that you had a choice between a blood or breath test?	Yes No
If so, which test did you take?	Blood Breath
If you took a breath test, was the officer continuously observing you 15 minutes prior to the administration of that test?	Yes No
If you took a chemical test (i.e., blood or breath), do you know the result?	Yes No
If so, what was the result? (Example: .08, .12, .20)
Were there any witnesses to your driving and/or arrest?	Yes No
Did the officer advise you of your Miranda Rights?	Yes No
Are you aware if you were videotaped at anytime during your arrest?	Yes No
Additional Comments:
*Security Code: Explanation