Free DUI Evaluation Form

Background Information

Full Name (*)

Driver license number (*)

Date of birth (*)

Phone number (*)

Email Address (*)

Specific Case Circumstances

Date of Arrest (*)

Why were you pulled over? (*)

If accident, was anybody hurt?
YesNo

Were you traveling on the freeway or surface streets?

What was the speed limit?

What was the status of your driver's license? (*)

Did the officer see you driving the vehicle?

Was there anybody under the age of 14 in the vehicle at the time?

How many drinks did you tell the officer you had that night? (*)

What time did you tell the officer you had your last drink? (*)

What time were you pulled over? (*)

BEFORE you were arrested, did you take a breathalyzer, also known as a PAS test?

If yes, what was your PAS result?

If yes, did you burp or regurgitate within the 15 minutes before you the PAS test?

AFTER you were arrested, did you take a breath test or blood test?

If yes - breath or blood or both?

If breath or both, what were the results of your breath test?

If breath or both, did you burp or regurgitate anytime within the 15 minutes before your breath test

Was your car stop or DUI arrest videotaped?

If there are any other crimes that you're being charged with, what are they?(*)

Court Information

County of Arrest

Date of Next Court Appearance (*)

Is this your first court appearance?

If no, how many court appearances have you already had?

If no, do you have a trial date set?

If no, are you currently represented by another lawyer?

Have you already requested a DMV hearing?

Criminal History

Have you ever been convicted of any misdemeanor or felony in the past?

Are you currently on probation or parole?

Do you have any prior DUI convictions on your record?

If yes, how many?

If yes, do have any prior FELONY DUI convictions?

Do you have any driving points on your record, i.e. speeding tickets, red light violations, etc. ?

If yes, how many points in the last 12 months?

If yes, how many points in the last 18 months?

If yes, how many points in the last 24 months?

Immigration Status

What is your immigration status? (*)

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