Free Case Review

Full Name

Home Address

City

State

Zip

Home Phone

Cell Phone

E-mail Address

yes no Are you interested in fighting your case?

Court Date

Time of Court

Court Location

Date of Arrest

Time of Arrest

City/Town Where Arrest Occured

Location/Street Address of Arrest

yes no Did you take a breath test at the scene?

What was the result?

yes no Did you take a breath test at the station?

What was the result?

yes no Was your blood taken for testing?

What was the result?

yes no Is this your first DUI?

List any previous DUI arrests including dates, locations and dispositions.

List all tickets received with this DUI.

Why did the officer say he/she stopped you?

yes no Was there an accident?

Who was injured?

no yes Were you stopped at a roadblock/safety stop?

yes no Were you given any field sobriety tests?

Check off all tests that were given.

Portable Breath Test (prior to arrest)

Walk And Turn On The Line

Stand On One Leg

Finger To Nose

Eye Test (horizontal gaze nystagmus)

Counting

Alphabet

Picking Up Coins

Other Tests Given

yes no Do you want to challenge the possible suspension of your drivers license?

Do you need your driving privileges for (check all that apply):

Work

School

Medical Care

Transporting Children

Personal Errands