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DUI Questionnaire


Law Offices of Jeff Voll www.CrimeAttorney.com

DUI/DWI Questionnaire

1. Did the officer take your driver's license or give you a paper called "Administrative Per Se Order of Suspension/Revocation, Temporary Driver License Endorsement"?Yes
No

2. Have you contacted the DMV as requested on the Administrative Per Se Order?:
Yes
No
If not, immediately call us toll free at 800-69OO-DUI

3. If you have contacted the DMV within the 10 day limit, when is your appointment (date and time)?:

4. Have you ever been arrested for a DUI/DWI charge before?
Yes
No

5. What date were you arrested for the current offense?:
 (mm-dd-yyyy)

6. Approximately what time were you arrested?:

7. Approximately how many minutes went by from the time you were arrested (when they handcuffed you) until you arrived at the chemical test location (blood, breath or urine test location)?:

8. 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)?:

9. Did the officer have a valid reason for stopping or contacting you while you were in your vehicle?:
 Yes
No
I don't know/not applicable

10. What did the officer say was the reason for the traffic stop or contact with you (check any that apply)?:
 - Speeding
- Weaving
- Involved in accident - No injury to anyone
- Involved in accident-Injuries to at least one person
- Roadblock/Checkpoint
- Unknown - I don't know
- S/he didn't tell me

11. If none of the above apply, please indicate the reason for the stop of your vehicle or contact with you?:

12. Did the officer see you driving?:
Yes
No
I don't know/not applicable

13. Did you admit to driving?:
Yes
No
I don't know/not applicable

14. If you consumed alcoholic beverages, what type did you drink(s) (highlight all that apply)?:

15. If 'Other', please indicate type of beverage?:

16. Think about the drinks you had. Many people under estimate how many drinks they had, or cannot remember. However, this is extremely important to your case. 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 glass of wine, or 1 shot (1 1/4 ounces of hard liquor)?:

17. Approximately what time did you finish your LAST alcoholic beverage before you were pulled over?:
 I don't know/not applicable

18. What time did you tell the officer you last drank?:

19. If you were on prescription medications or other drugs, what type? (highlight all that apply)?:

20. If 'Other', please indicate type of medication or drug?:
 I don't know/not applicable

21. What size meal did you have before the arrest?:

22. When, before the arrest, did you eat?:

Analysis Questions-Field Sobriety Tests/Reasonable Cause to Arrest

23. Did you perform any coordination or balance tests (Field Sobriety Tests - FST's) prior to being arrested?:
Yes
No
I don't know/not applicable

24. Please select the field sobriety tests you were requested to perform? (check all that apply):
 - Did not take any field tests
- Follow a pen, finger, or other object with you eyes, not moving your head
- Standing with my head tilted back and eyes closed, feet together
- Standing on one foot for a period of time and counting
- Patting your hands together
- Counting on your fingers
- Saying or writing the ABC's
- Walking a straight line, or heel-to-toe
- Touching your nose with finger
- Other

25. If 'Other', please indicate what they made you do?:
 I don't know/not applicable

26. Did you blow into a field breathalyzer or hand-held type gadget?:
Yes
No

27. If you know, what was the result of the hand-held breathalyzer gadget test?:
 I don't know/not applicable

28. Did the officer advise you that you could refuse to take the hand-held gadget breath test?
Yes
No
I don't know/not applicable

29. Did you fail to satisfactorily perform the balance and coordination tests as demonstrated to you by the officer?:
Yes
No
I don't know/not applicable

Analysis Questions - Chemical Test/Chemical Test Refusal

30. Please select the type of chemical test you took (or whether you took a chemical test at all):
Blood
Breath
Urine
No Chemical Test Taken
I don't know/not applicable

31. What were the results of the test, if you know?:
 I don't know/not applicable

32. Did you take the chemical test (blood, breath or urine at the station or jail) within 1 1/2 hours after finishing your last drink?:
Yes
No
I don't know/not applicable

33. If you are charged with refusing a chemical test - Which of the following apply?
The cop told me I would have my license suspended if I refused a
blood, breath or urine test, and I refused anyway.
I refused during the initial vehicle stop or contact with the cop.
I refused when they handcuffed me.
I refused in the patrol car.
I refused on the ride, in the patrol car, to the chemical test location.
I refused at the chemical test location.
I refused everything from the beginning.
The cop told me I refused when he first stopped me.
The cop told me I refused when we were doing Field Tests.
The cop told me I refused when he handcuffed me.
The cop told me I refused when we were in the car.
The cop told me I refused when we were driving to the chemical test location.
The cop told me I refused when we were at the chemical test location,
but he didn't tell me I would lose my license if I refused.
The cop told me I could refuse the test when he used a hand-held breathalyzer, so I did.
The cop never told me I had to take a test and he didn't tell me I
would loose my license for refusing.
Other

34. If "other", please explain what happened:

If you took a breath test (NOT the hand-held road test):

35. After you arrived at the place where the breath machine was located, did you wait at least 15 minutes before your first breath into the machine?:
Yes
No
I don't know/not applicable

36. If at least 15 minutes went by after arriving where the breath machine was located, what were you and the officer(s) doing during that period of time (highlight all that apply)?

37. If 'Other', please indicate what happened?:

38. After the breath test was completed, did the officer advise you that you had the right to take a blood or urine test, in addition to the breath test, to insure the accuracy of the breath machine or so you could have a sample collected for future testing?:
Yes
No
I don't know/not applicable

39. Did you take an additional blood or urine test?

If you took the urine test:

40. For the urine test, did you completely empty your bladder the first time you urinated?:
Yes
No
I don't know/not applicable

41. If no, why not?:

42. For the urine test, did the officer collect your urine the second time you urinated?:
Yes
No
I don't know/not applicable

43. For the urine test, did an officer watch you closely or fail to respect your privacy when you provided the sample?:
Yes
No
I don't know/not applicable

44. What type of law enforcement officer was the arresting officer (the one who gave you tests, handcuffed you, took you to jail)?:

45. Please input the arresting officer's last name and badge or serial number if you know it:

Information necessary to contact you for an evaluation
and/or to confirm the survey data entered with public records

46. Name the city where the arrest took place?:

47. In which California Superior Court are you scheduled to appear?:

48. In which Nevada Justice or Municipal Court are you scheduled to appear?:

49. When is your court date?:

50. Have you consulted with another attorney since your arrest?:
Yes
No

51. Are you aware that a conviction and/or driver's license suspension for DUI/DWI will result in an insurance cancellation or a possible increase in cost between $15,000 to $25,000 during the next seven years?:
Yes
No

 

Your Name: 

Email Address: 

Your Home Address: 

City: 

State: 

Zip: 

Home Phone: 

Business Phone: 

Pager Phone: 

Mobile Phone: 

Fax Number: 

Contact Preference (how do you want to be contacted?): 

Date of Birth: 

Driver License Number and State: 

Occupation: 

Annual Income: 

What is your budget to have an attorney represent you?: 

Place of Employment: 



Congratulations. If you have checked your answers, please either send the email by pressing the below button, or you can erase all data fields by clearing them below.

 


This information will be used to help evaluate your case. An appointment for a FREE initial case evaluation and consultation by an Attorney can be scheduled ONLY if you request. There is no fee for this service. Remember to call us ANYTIME TOLL FREE at (800)6900-DUI if you have any questions.
To find out more information about these topics, please call us direct at (888)880-CRIME or (888)884-ABOGADO.

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Law Offices of Jeff Voll
Main Office:
3460 Wilshire Blvd., Suite 1209
Los Angeles, CA 90010
email: jeffvoll@yahoo.com

Law Offices of Garrett Ogata
3841 W Charleston Blvd.
Suite 205
Las Vegas, NV 89102


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Call us Toll Free at (888) 880 - CRIME