DeVore Law Office, P.A. DWI Preliminary Form

DWI Preliminary Form

If you are serious about defending your DUI, record this information while its still fresh in your memory. We will call you after we receive your email report. Please include telephone contact information. It is very important to discuss these matters personally. Submissions without telephone contact information will be discarded.

Instructions for interview: Please answer the questions as truthfully as possible; do not guess at an answer (approximations are fine, but not as reliable). The results depend on your truthfulness. Please answer the questions in the overview survey. Additionally, if you wish, please also feel free to answer the questions in the Additional Information portion of the survey. This will better help us understand your case.

Name:
Email:
Phone:
Your Current Arrest Matter:
Date of your current arrest?
Was your license valid on this most current arrest (ie. not suspended or revoked for another reason)?	Yes No

Preliminary Questions
Have you ever been arrested for DUI/DWI before?	Yes No
If 'yes', what approximate date(s) was(were) your previous DUI/DWI(s)?

City and State where arrest took place?
Scheduled to appear in which County?
What date and time is your court date?
What did the officer indicate to you as the reason for the traffic stop or contact with you?

If none of the above apply, please indicate the reason for the stop of your vehicle or contact with you?
Analysis Questions-Reasonable Cause to Arrest:
Did you take any field balance/coordination (field sobriety tests - FST's) tests prior to being arrested and handcuffed?	Yes No Don't Know/Not Applicable
Were you ordered or did you do them voluntarily?	Ordered Voluntary
Please select the field sobriety tests you were ordered to perform (check all that apply)?

If 'Other', please indicate what they made you do?
Did you blow into a field breathalyzer or hand-held type gadget?	Yes No
If you know, what was the result of the hand-held breathalyzer gadget test?
Did the officer advise you that you could refuse to take the hand-held gadget breath test?	Yes No Don't Know/Not Applicable
Did you fail to satisfactorily perform the balance and coordination tests as demonstrated to you by the officer?	Yes No Don't Know/Not Applicable

Analysis Questions - Chemical Test/Test Refusal:
Did you take a blood, breath or urine test?	Yes No Don't Know/Not Applicable
If you took a chemical test, did you take a blood, breath, or urine test?	Blood Breath Urine Don't Know/Not Applicable
Did you take the chemical test (blood, breath or urine at the station) within 2 hours of driving?	Yes No Don't Know/Not Applicable
Did you select (choose for yourself) the chemical test if you took at least one (i.e. the blood, breath, or urine test)?	Yes No Don't Know/Not Applicable
If 'yes' type in the test and the results if you know:
If you are charged with refusing a chemical test, where or when did you supposedly refuse?

If you refused, but later changed your mind, please give details:

Personal Information - Strictly Confidential * required fields
Your Home Address:
Your ZIP code: *
Secondary Phone:
Cell Phone:
Facsimile Number:
Contact Preference (when is the best time to contact you)? *
Date of Birth:
Driver License Number:

if you wish, please also feel free to answer the questions in the Additional Information portion of the survey. This will better help us understand your case. If not, please hit send now.

Additional Information
Think carefully about these next few questions:
Approximately how many minutes went by from the time the officer stopped/contacted you until he put the handcuffs on you?
Approximately what time were you first contacted by the officer?
Approximately what time were you arrested (handcuffed)?
Approximately how many minutes went by from the time you were arrested (when they handcuffed you) until you arrived at the blood, breath or urine test location?
Approximately how many minutes went by from the time you arrived at the chemical test location until you took the first chemical test (blood, breath or urine test)?

Have you contacted the Department of Motor Vehicles/Department of Safety yet?	Yes No
Analysis Questions - Probable Cause:
Did the officer see you driving, or if s/he did not, did you admit to driving a vehicle?	Yes No Don't Know/Not Applicable
Did the officer have a valid reason for stopping you in the vehicle?	Yes No Don't Know/Not Applicable

Did you drink any alcoholic beverages, and/or take any drugs, within 10 hours of being stopped by the officer?	Yes No Don't Know/Not Applicable
If you drank alcoholic beverages, what type (highlight all that apply)?
If 'Other', please indicate type of beverage?
Think about the drinks you had. Many people underestimate how many drinks they had, or cannot remember. This can be extremely important to your case though. In order to calculate your Blood Alcohol Level please indicate how many drinks you had total (one drink is equal to a 12 ounce beer, a regular 4 ounce glass of wine, or, 1 shot or 1 ½ ounces-of hard liquor)? Number of servings of alcohol:
Approximately what time did you finish your LAST alcoholic beverage?

If you were on prescription medications or other drugs, what type (highlight all that apply)?
If 'Other', please indicate type of medication or drug?

What size meal did you have within three (3) hours of drinking or drug use?
If 'Other', please indicate size of meal?
Did you feel the effects of the alcohol you drank, or drugs you were taking, when you were driving (i.e. feel a buzz, feel drunk or high)?	Yes No Don't Know/Not Applicable
If you drank after driving, please explain:

Due Process Under the Law:
What type of law enforcement officer was the arresting officer (the one who gave you tests, handcuffed you, took you to jail)?

Please input the arresting officer's last name and badge or serial number:
Please input the agency that the officer worked for (ie. San Francisco Police Department):
Did the officer treat you fairly and professionally?	Yes No
Please enter any comments about the officer below:

Please enter any comments or things you think your attorney should know that is not asked for on questionnaire:
Have you consulted with another attorney?	Yes No
Is it your goal to win your DUI case?	Yes No
Is it your goal to save your Driver's License from suspension/revocation?	Yes No
Are you aware that DUI/DWI cases can be successfully defended?	Yes No
Are you aware that a conviction and/or driver's license suspension for DUI will result in insurance cancellation or an increase cost?	Yes No

Occupation:
Annual Income:
Place of Employment:
What is your budget to defend your current case?