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 (to save your driving privileges) yet?:
Yes
No


If not, immediately contact 1-800-THE-LAW-DMV (1-800-843-5293)

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


3. Have you ever been arrested for DUI before?
Yes
No

4. What date and time were you first detained/arrested by the officer?:


5. 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)?:


6. 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)?:


7. Did the officer have a valid reason for stopping or contacting you in the vehicle? (if not - we can win):
Yes
No
I don't know/not applicable

8. What did the officer indicate to you as 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


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

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

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

11. If you drank alcoholic beverages, what type (highlight all that apply)?:
None consumed Beer-Regular Beer-Microbrew Beer-Malt Liquor Wine-Red Wine-White Gin Vodka Rum Tequila Martini Long Island Iced Tea Other

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


12. Think about the drinks you had. Many people under estimate how many drinks they had, or cannot remember. This is 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 glass of wine, or 1 shot-1 1/4 ounces-of hard liquor)?:
None consumed One (1 drink) Two (2 drinks) Three (3 drinks) Four (4 drinks) Five (5 drinks) Six (6 drinks) Seven (7 drinks) Eight (8 drinks) Nine (9 drinks) Ten (10 drinks) Eleven (11 drinks) Other amount of drinks

13. Approximately what time did you finish your LAST alcoholic beverage?:
I don't know/not applicable

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


15. If you were on prescription medications or other drugs, what type? (highlight all that apply)?:
Not Applicable Anti-depressant Pain medication Valium/Tranquilizer Marijuana Methamphetamine Powdered Cocaine 'Crack' Cocaine Heroin 'Ecstasy' Other

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

16. What size meal did you have before the arrest?:
Hadn't eaten within the time limit Bar Snacks Small meal Medium meal Large meal Extremely large meal Other meal

When, before the arrest, did you eat?:

17. 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
- 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

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

18. 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?:
I don't know/didn't tell me

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

19. 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

20. 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

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

21. If you are charged with refusing a chemical test,
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


If "other", please explain what happened:

21. For the breath test, 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

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)?
The officer(s) sat and watched me do nothing. The officer(s) were doing reports. The officer(s) were doing reports and talking with me and each other. I was chewing. I was sick. I was regurgitating. I was having indigestion. I was belching or burping. I was drinking. Other

If 'Other', please indicate what happened?:


22. 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

Did you take an additional blood or urine test?
I did not give an additional sample. I wasn't sure if I should give an additional sample. I knew I was over the limit anyway. I don't remember. The officer(s) talked me out of doing it. The officer(s) told me it would be used against me too. The officer(s) didn't tell me about this right of mine. I gave a urine sample after the breath test. I gave a blood sample after the breath test. Other

23. What type of law enforcement officer was the arresting officer (the one who gave you tests, handcuffed you, took you to jail)?:
California Highway Patrolman Local Sheriff Deputy City Police Officer Other Law Enforcement Officer

Please input the arresting officer's last name and badge or serial number:

24. Name the city where arrest took place?:


Where are you scheduled to appear in which California Court?:
Chula Vista (South Bay) El Cajon (East) San Diego (Downtown) Vista (North) Other

25. When is your court date?:


26. Have you consulted with another attorney?:
Yes
No

27. Is it your goal to win your DUI case and/or is it your goal to save your California Driver's License or Driving Privileges from suspension/revocation?:
Yes
No

28. Are you aware that DUI and DMV cases can be successfully defended?:
Yes
No

29. Are you aware that a conviction and/or driver's license suspension for DUI will result in 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?:

Cell Phone?:

Facsimile Number?:

Contact Preference (how do you want to be contacted, i.e. be discreet, "Rick
Mueller (a friend)", etc.)?:


Date of Birth?:

Driver License Number and State?:

Occupation?:

Annual Income?:

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

Place of Employment?:

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