About Our Firm

Name of person arrested:  

Where were you coming from prior to the traffic stop or accident? (restaurant, bar, home, etc.)

How long had you been driving just prior to the stop or accident?

What time was it when were you stopped or involved in an accident?

When did you consume your first drink that day?

When did you finish your last drink that day?

*How many drinks did you have? (One drink is a 12 oz. beer, 4 oz. of wine, a "shot" or mixed drink with only 1¼ oz. of 80 proof liquor)

Gender: Male    Female   

What is your height?       What is your weight?  

Was any alcohol consumed after you were driving? (e.g. Using a breath spray as the officer approaches, returning home after an accident and consuming alcohol, etc.).

Was any food consumed within 8 hours of the traffic stop/accident? Yes    No   

What time was it and what did you have to eat before the incident?

How many hours of sleep did you get the night before?  

If you were stopped by a police officer, what was the reason given for the stop?

Was your vehicle impounded? Yes   No         If so, has your vehicle been returned to you? Yes   No   

Please describe your vehicle or the vehicle you were driving:

Year

Make (e.g. Chevy, Ford, Toyota, BMW etc.)

Model (Malibu, Taurus, etc.)

Type of vehicle (car, truck, van, SUV etc.)

Color:

If you were involved in a traffic accident was anyone injured? Yes    No   

If so, please describe:

Were you taking any medications or drugs at the time? Yes    No   

If so, what drugs/medications were you taking and how much?

Were passengers in your vehicle? Yes    No   

If so, how many?

What were their names?

Was there a child in the vehicle? Yes    No   

(A person convicted for DUI with a child under the age of 14 in the vehicle is subject to a mandatory 48 continuous hours in jail. 23572 CVC).

Prior to being stopped/accident, could you have been speeding more than +20 mph over the speed limit on a street or +30 mph over the speed limit on a freeway? Yes    No   

(A person convicted for DUI found to be driving recklessly and at an excessive speed is subject to an additional consecutive 60 days in jail! 23582 CVC).

Did you have a valid Driver License at the time? Yes    No   

Did the officer take your license? Yes    No   

Did the officer give you a Temporary Driver License and a "Notice" to contact DMV? Yes    No   

IMPORTANT !! PLEASE NOTE !! DMV must be contacted within 10 days of your arrest to request a hearing to stop your AUTOMATIC DRIVER LICENSE SUSPENSION !! We can make this request for you. If the 10 days is about to expire, please call us immediately at (888) 579-4844.

Did you perform some field sobriety tests "F.S.T.'s"? Yes    No   

Please check each that apply:

Horizontal Gaze Nystagmus - HGN (Stand keeping head still, follow a finger or pen with your eyes).

Modified Position of Attention - Rhomberg (Stand both feet together, arms at side, head tilted back, eyes closed and estimate 30 seconds).

Leg Raise - (Stand with feet together, arms at side raise one foot approximately six inches off ground).

Finger Count - (Touching tip of your fingers to the tip of your thumb).

Hand Pat - (Patting the palm and back of your hand).

Finger to Nose - (Standing at attention, head tilted back, eyes closed, touching the tip of your index finger to the tip of your nose).

Walk the Line - (Walking heel to toe several steps, turn around and walk back heel to toe).

Reciting the Alphabet

Counting

Other, please describe:

Were you injured or do you have any previous injuries/illnesses or limiting physical disabilities? (Eg. bad back or knees, inner ear infection, epilepsy, diabetes, poor balance, etc.) that would have possibly affected how you performed on the FST's (balance and co-ordination tests.) Yes    No   

If so, please describe:

Prior to being arrested and taken to the station, did the officer have you blow in to a hand-held breath tester (Preliminary Alcohol Screening- PAS/PBT device) at the traffic stop/accident scene? Yes    No   

Do you know your breath alcohol reading(s)? Yes    No   

Did the officer tell you that the PAS test was voluntary? Yes    No   

If so, what were your readings (The officer might say something like: "point-oh-eight" or .08, .14 or .22%, etc.):
My readings were (in the field):      (at the station): 

After you were arrested, were you advised that you had a choice of taking either a blood or breath chemical test to determine the alcohol content of your blood? Yes    No   

Which test did you take:   Blood       Breath      Urine      I refused to take a test

If you refused to take a chemical test, did the officer advise you that you could loose your license for a minimum of one year? Yes    No   

A person convicted of DUI and Refusing to take a chemical test faces additional mandatory jail time

If you know the results of the "Chemical Test", what was your blood alcohol level?    % (A Blood Alcohol Concentration - "BAC" over a 0.20% may result in increased court penalties).

How much time elapsed from the time you were arrested (handcuffed) until the time that you took the chemical test? (Like blowing into the machine at the station or having your blood drawn.)  

Do you have any medical condition(s) or dental work that could trap food particles in your mouth or that could have caused you to burp or regurgitate (e.g. GERD -Gastro-Esophogeal Reflux Disorder) within the 15 minutes prior to your giving a breath sample? Yes    No   

(Note: If you burped or regurgitated within the 15 minutes immediately prior to a breath test, the machine may have given an erroneously high reading).

Details:

Did the officer read you your Miranda Rights (Right to Remain Silent)? Yes    No   

Did you "waive" or give up your rights and agree to speak to the officer? Yes    No   

Did you answer the officer's questions? Yes    No   

Have you had previous DUI/DWI convictions? Yes    No   

If so, please name the State and give us the approximate date of arrest or date of conviction, Court and charge(s) for each prior DUI conviction.

Date:

Location(Court):

Prior Offense (Charge):

Do you have some other comments to share with us before we contact you?