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DUI Questionairre

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Last Name*
Email Address*
Day Phone Number*
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Case Details
Which court are you supposed to appear in?
 
When is your first court date?
  
 
Was your car registration valid?
 
Yes No  
If not, why?  
 
Have you been convicted of a DUI in the last 10 years?
Yes No  
If so, how many times, when, which court(s)?
 
Were you involved in an accident in this case?
Yes No  
If so, provide insurance policy.  
 
What was the reason(s) the officer gave for pulling you over in this case?
 
What was the make, model, color and year of your vehicle?
 
What were the cross streets where you were pulled over by the police officer?
 
What city and county were you pulled over in?
 
What did you tell the police about what you had to drink and when you consumed the drinks?
 
What time were you released from jail?
 
Under 21 years of age at the time of the arrest? Yes No
Any mechanical problems with your vehicle? Yes No
Was there a child under 14 years of age in the car? Yes No
Did you refuse to take a chemical test? Yes No
Was your blood alcohol level over 0.16? Yes No
If you were on the freeway, were you speeding over 30 mph beyond the posted speed limit? Yes No
If you were on surface streets, were you speeding over 20 mph beyond the posted speed limit? Yes No
If you were involved in an accident, were there any injuries to anyone in your vehicle or the other party's vehicle? Yes No
Did the officer ask you to perform a field sobriety test? Yes No
Did you perform a field sobriety test? Yes No
Did the officer advise you of your Miranda rights? Yes No
If so, did you waive your Miranda rights? Yes No
What Type of Test did you take?
If you took a breath test, was the officer continuously observing you for fifteen minutes prior to the administration of that test? Yes No
If you took a chemical test (i.e., blood or breath test), do you know the result? Yes No
If so, what was the result?
If you took a breath test, how many times did you blow into the machine?
Check each box that applies:
I'm Diabetic
I'm Epileptic
I have dental work in my mouth.
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