Case Evaluation

Personal Information

Name (required)

Email (required)

Phone number (required)

Drivers license number

Date of birth (MM/DD/YYYY)

Court Information

Court where you are scheduled to appear

Date you are scheduled to appear (MM/DD/YYYY)

Is this your first DUI?
YesNo

Are you currently on probation or parole?
YesNo

Incident Information

Date of arrest (MM/DD/YYYY)

Time of arrest

City where you were arrested

Which law enforcement agency arrested you?

Did the officer observe you driving a vehicle?
YesNo

Did you admit to driving the vehicle?
YesNo

Was there an accident?
YesNo

Were you stopped at a roadblock?
YesNo

Were you under 21 years of age at the time of the arrest?
YesNo

Was there a child under 14 years of age in the vehicle at the time of the arrest?
YesNo

If you were on surface streets, were you speeding 15 mph or more beyond the posted speed limit?
YesNo

Did you tell the officer you had been drinking?
YesNo

What time did you tell the officer that you had your last drink?

Did you perform any Field Sobriety Tests?
YesNo

Did the officer ask you to blow into a handheld breath device at the scene?
YesNo

How many times did you blow into the breath device?

If you took a chemical test (i.e. blood or breath), do you know the result?
YesNo

If you took a breath test at the station, how many times did you blow into the machine?

Were there any witnesses to your driving and/or arrest?
YesNo

Did the officer advise you of your Miranda Rights (i.e. right to remain silent)?
YesNo

Do you know if you were videotaped at any time during your arrest?
YesNo

Additional comments