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DUI Questionnaire

Please answer all questions to the best of your recollection of the stop and the arrest. The more complete and accurate the information, the better we will be able to prepare and consult you in our conversation about your defense.

Your Contact Information

Title

First Name *

Last Name *

Email Address *

Contact Phone Number *

Home Phone Number

Referred by:

Home Address

City

State

Zipcode/Postcode

Country

Employer

Employer Address

Licenses you hold:

CDL?
Yes
No

Pilot License?
Yes
No

Professional License
Yes
No

Type of Profession

Your Georgia DUI Case

State of Stop

Date of Stop

County of Stop

Police Agency

Was there an accident involved?

Why were you stopped?

Police officer's first comments:

Did Police ask you how much you had to drink?

What did you tell the Officer?

What and how much did you drink/smoke/other?

Were field test performed?

Were you informed that they are voluntary?

Were Miranda rights read to you?

Which field tests were administered?
HGN-Eye
One Leg Stand
Count to 30
Walk and Turn
Finger to Nose
ABC's
Five Finger Dexterity
Portable Breath Test

What were the results of the breath test?

At what point were you arrested?

Was the following read to you?

Did you blow into the Intoxilyzer 9000?

Did you refuse the test?

Did you request an explanation?

Did you ask for an independent test?

Reason given for refusal:

How was blood taken?

How was blood sent to lab?

Location of Court

Do you need a Ten Day Letter?
Yes
No
I Don't Know