Free Case Review

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©

Full Name: *
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Company:
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ZIP:
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Home Phone:
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Email Address: *
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Date of Arrest:
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Time of Arrest:
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Town/Municipality Where Arrested Occurred:
 
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Day of Week:
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Court Date:
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Time of Court:
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Place of Court:
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Street or location where you were stopped:
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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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Result:
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Was there a blood 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, even if dismissed?
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Please list all prior DUI/DWI/Drunk Driving Arrests 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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Other tickets/Charges received with your present DUI Charge:
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Other:
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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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Were you stopped at a roadblock?
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Were you given field sobriety tests at the scene, hospital or police station?
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Which tests were you given? (Check all that apply):
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Other:
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Did any police tell you that the tests were optional (you could refuse)?
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Were you videotaped at the scene or police station?
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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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At any time did the police tell you that (check all that apply):
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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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Were you under any kind of doctors care on the date of your arrest?
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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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Do you have any prior injuries, or present disabilities, that might have affected your driving or testing that night/day?
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Additional Comments:
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