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DWI Free Consultation Questionnaire

The more we know about your case, the better. Please complete as much of the questionnaire as is appropriate for your case. If you don't have time, that's okay; just fill in your contact information (* required fields), and one of our qualified DUI / DWI defense lawyers will get in touch with you right away.

First Name:

Last Name:

County:

Phone:

Best Time to Call:

Q1:	Have you ever been arrested before?	Yes No
Q2:	Was there an accident?	Yes No
Q3:	Did you commit any traffic infractions?	Yes No
Q4:	Was there a DWI checkpoint?	Yes No
Q5:	Was your car seized?	Yes No
Q6:	Did you take a breath test in the precint?	Yes No
Q7:	What was your breath test reading? (If you know.)
Q8:	Did you refuse a breath test?	Yes No
Q9:	Did you perform coordination tests at the roadside?	Yes No
Q10:	Did you perform coordination tests in the precinct?	Yes No
Q11:	Did the police take a Video of you?	Yes No
Q12:	Did you take a blood test?	Yes No
Q13:	Did you take a urine test?	Yes No
Q14:	Were there any passengers in your car?	Yes No
Q15:	Were you driving?	Yes No
Q16:	Do you have an out of state driver's license?	Yes No
Q17:	Do you have a commercial driver's license?	Yes No

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