To contact me you can call my 24
Hour Hotline 1-800-609-1060
or fill out the following form
DUI Interview Form
Please be sure to fill in the telephone contact information so that I can get back to you. In order for me to provide you with the most accurate and helpful information, be sure to fill out this form truthfully, and as accurate as you can. Any information will be considered confidential.
| Have you ever been arrested for a D.U.I., "Driving Under the Influence"? : | ||
| -if the answer was yes, what was the approximate date of arrest?(mm/dd/yy) : | ||
Have you ever been convicted of Driving under the Influence of alcohol or narcotics? : | ||
What was the time of arrest? : | ||
What was the time that the officer contacted/stopped you? : | ||
Did you take a B.A.C., or Blood Alcohol Content test? : | ||
| -if so, which test and or tests did you take? : | ||
| -how much time elapsed from the time you were arrested, to taking the B.A.C.? : | ||
What reason if any was given for being pulled over?: | ||
Did the officer act in a professional manner? : | ||
Did the officer see you driving the vehicle? : | ||
| -if not, did you admit to driving the vehicle? : | ||
Did you drink any alcohol or take drugs anytime before being pulled over? : | ||
| -if so, how much time passed before being pulled over? : | ||
| -if so, what did you drink/take, and how much did you drink/take?: | ||
Were you under the influence of drugs/alcohol when operating the vehicle? : | ||
Did you take a F.S.T.or Field Sobriety Test? : | ||
| -if so, did you pass or fail? : | ||
| -if so, did you volunteer, or were you ordered to? : | ||
Did you take the hand-held breathalyzer test? : | ||
| -if so, did the officer advise to you that you could refuse? : | ||
| -if so, what was the result of the test? : | ||
What City / State were you stopped? : | / | |
When is your court date? : | ||
| -what time? : | ||
Is there any other relevant information not asked about in this form you would like to submit? : | ||
Is keeping your drivers license important to you? : | ||
Have you contacted the D.M.V.? : | ||
| -when is your revocation hearing? : | ||
| -did you request the officer's presence? : | ||
| -is there a reason you didn't contact the DMV? : | ||
| -if so, what?: | ||
NAME (First,Last): | ||||
| DRIVERS LICENSE: | ||||
| OCCUPATION: | ||||
| EMAIL ADDRESS: | ||||
| HOME ADDRESS: | ||||
| PHONE: | ||||
| ALTERNATE PHONE: | ||||
| BEST TIME TO CALL: | ||||
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