7 DAY WARNING!!!! In many States you only have 7 to 30 days to challenge your case or you will LOSE your driver's license AUTOMATICALLY!! WARNING!! Call 1-800-DIAL-DUI IMMEDIATELY to Protect your driving privileges!!
IF YOU ARE FACING A CHARGE FOR DUI/DWI/DRUNK DRIVING, YOU CAN RECEIVE A FREE EVALUATION OF YOUR CASE BY COMPLETING THE ABOVE CONFIDENTIAL QUESTIONNAIRE, OR BY SIMPLY CALLING US TOLL-FREE AT:
NOTE: Fields with a * indicate a required field.
Full Name *
Phone Number *
Are you interested in fighting your case for the best result possible?
Date of Arrest
Time of Arrest
Town/Municipality Where Arrested Occurred
Day of Week
Time of Court
Place of Court
Street or location where you were stopped
Was there a breath test taken on the scene? Result?
Was there a breath test at the police station? Result?
Was there a blood test taken? Result?
Is this your first arrest for DUI/DWI/Drunk Driving in your lifetime-anywhere, even if dismissed?
Please list all prior DUI/DWI/Drunk Driving Arrests below, including year, city/state, and outcome (if known)
Are you currently on probation/parole for any DUI or criminal case?
If YES, for what offense(s)
Other tickets/Charges received with your present DUI Charge
Why were you stopped according to the police officer?
Was there an accident? Was anyone injured?
Were you stopped at a roadblock?
Were you given field sobriety tests at the scene, hospital or police station?
Which tests were you given?
Did any police tell you that the tests were optional (you could refuse)?
Were you videotaped at the scene or police station?
Do you want to challenge the possible suspension of your drivers license?
What for do you need driving privileges?
At any time did the police tell you that your have the right to remain silent
At any time did the police tell you that you have the right to an attorney of your choosing
At any time did the police tell you that if you cannnot afford an attorney, one will be appointed for you
At any time did the police tell you that anything you say will be held against you in court
At any time did the police tell you that you can stop talking at any time
Did you ever tell the police that you wanted to speak to an attorney?
Did you ever ask for an independent test of your own?
Is it possible that there was drugs/medications in your system?
Were you under any kind of doctors care on the date of your arrest?
Are there any witnesses who were with you before or during your driving that can testify for you?
Do you have any prior injuries, or present disabilities, that might have affected your driving or testing that night/day?
The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.
The DUI attorneys and DWI lawyers listed on this site include nationally published authors on DUI laws and DWI laws. These Drunk Driving Defense Attorneys have appeared in over 75 local television stations and 229 newspapers nationwide.