Intake

Contact Information:

Name (required)

Street Address (required)

Street Address (required)

Phone (required)

Email (required)

Details of Arrest:

What date were you arrested on?

Is your charge alcohol or drug related?
 Alcohol Drugs

Give a brief description of what happened?

Were field sobriety tests given to you?
 Yes No

Did you give blood, urine or breath samples?
 Blood Breath Urine None

Do you have any prior DUI charges?
 Yes No
If so, when did each prior charge occur and what was the outcome of each (i.e. dismissed, reduced, acquittal, or conviction)?

Is there other information you believe is important about your case?