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DUI Interview
DUI Interview
Contact Information:
Name:*
Email:*
Address:
City:
State:
ZIP:
Home Phone:*
Work Phone:
Where do you prefer to be contacted?*
Select
Home Phone
Work Phone
Email
Date of Birth:
Occupation:
Annual Income:
Place of Employment:
Current Arrest Matter:
1. Date of citation:
2. Did you have a valid driver's license?
Yes
No
3. City and county where arrest took place:
4. What date and time is your court date?
5. Did the officer take your driver's license and give you a temporary license?
Yes
No
6. Have you contacted the Dept. of Motor Vehicles regarding your license suspension?
Yes
No
6b. If you have contacted the DMV, when is your revocation hearing (date and location):
7. Did the officer see you driving, or if s/he did not, did you admit to driving a vehicle?
Yes
No
I don't know/not applicable
8. What did the officer indicate as the reason for the traffic stop or contact with you?
Speeding
Weaving
Involved in accident - no injuries
Involved in accident - injury to at least one person
Roadblock/checkpoint
Unknown
S/he didn't tell me
8b. If none of these apply, please indicate the reason for the stop of your vehicle or contact with you:
9. Did you drink any alcoholic beverages within 10 hours of being stopped by the officer?
Yes
No
I don't know/not applicable
10. If you consumed alcoholic beverages, what type?
Beer (regular)
Beer (microbrew)
Beer (malt liquor)
Wine
Gin
Vodka
Rum
Tequila
Martini
Long Island iced tea
Other
10b. If "other," please indicate type of beverage:
Think about how many drinks you consumed. This can be extremely important to your case.
Remember, a pint of beer is 16 ounces and should be counted as 1.25 drinks. If you were drinking doubles shots, then they are considered 2 drinks.
11. Number of drinks:
12. At approximately what time did you finish your last alcoholic beverage?
13. If you were on prescription medications or other drugs, what type?
Anti-depressant
Pain medication
Valium/tranquilizer
Marijuana
Methamphetamine
Powdered cocaine
Crack cocaine
Heroin
Ecstasy
Other
13b. If "other," please indicate type of medication or drug:
14. How long before you were stopped by the officer did you eat?
15. Did you drink or do drugs between the time of driving and the encounter with the officer?
Yes
No
16. Did you take any field sobriety tests (FSTs) prior to being arrested and handcuffed?
Yes
No
I don't know/not applicable
17. Were you ordered or did you do the field sobriety tests voluntarily?
Ordered
Voluntary
18. Please select the field sobriety tests you were ordered to perform.
Follow a pen, finger or other object with your eyes
Standing with head tilted back, eyes closed, feet together
Standing on one foot for a period of time
Patting your hands together
Counting on your fingers
Saying or writing the ABCs
Walking a straight line, or heel-to-toe
Touching your nose with finger
Other
18b. If "other," please indicate what they made you do:
19. If you took a chemical test, please indicate the test(s) you took:
Blood
Breath
Urine
I refused.
19b. If yes, type in the results if you know.
20. What type of law enforcement officer was the arresting officer (the one who gave you tests, handcuffed you, put you in jail?)
Select
Highway patrolman/trooper
Local sheriff deputy
City police officer
Other law enforcement officer
21. Please input the arresting officer's last name and badge or serial number:
22. Please input the agency that the officer worked for (ie. Portland Police Department):
23. Did the officer treat you fairly and professionally?
Yes
No
24. Please enter any comments about the officer below:
25. Have you ever been arrested for a DUI?
Yes
No
25b. If yes, please provide dates and locations of previous DUIIs:
26. Have you consulted with another attorney?
Yes
No
27. Is it your goal to win your DUII case?
Yes
No
28. Is it your goal to have the DMV suspension/revocation set aside?
Yes
No
29. Are you aware that a conviction and/or driver's license suspension for DUII will result in insurance cancellation and/or increased insurance rates?
Yes
No
30. What is your budget to defend your case?
31. Please enter any comments or things you think your attorney should know that is not asked for on this questionnaire:
I understand that this is a confidential questionnaire, and that it is used solely for the attorney's reference. I understand that submitting this questionnaire in no way obligates Matthew D. Kaplan, LLC Attorney at Law to represent me in this matter. Representation does not begin until a written retainer agreement has been signed by both parties.
DUI Law
DUI Penalties
DUI Interview
DUI Procedures
DMV License Suspensions
10 Common Mistakes
Diversion
Glossary
