QUESTIONNAIRE

dui questions gwinnett attorney law firmFill out the questionnaire to the best of your recollection.  Submit to us.  All information will be kept confidential. Someone from our office will contact you to set up an interview and we will evaluate your case.  All of this is FREE.

You can also call our office at (678) 869-5101.

WARNING:    If you are accused of refusing to take the State test after being arrested for DUI, if your test results were above the legal limit, or if you were served with a DDS 1205 Notice- 30 Day Driving Permit, your license is at risk of being suspended. You only have 30 days to request an Administrative Hearing or risk losing your driving privileges in Georgia. Call our office immediately to get more information about saving your driver’s license.

    Your Name (required)

    Street Address

    City

    State

    Zip Code

    County

    Email Address (required)

    Phone Number

    May We Contact You At This Number?

    YesNo

    Work Phone

    May We Contact You At This Number?

    YesNo

    How did you find us?

    Date of Arrest (required)

    Time of Arrest (required) (hh/mm/ss) (am or pm)

    Court Date (required)

    Court Time (required) (hh/mm/ss) (am or pm)

    Name of Court (required)

    Drivers License Number (required)

    State Where Licensed (required)

    Date of Birth (required)

    Is this your first DUI/DWI lifetime - anywhere, anytime?

    YesNo

    If you had prior DUIs - List below. (Month/Year - Court - (Guilty, Nolo, Not Guilty)

    Are you currently on probation or parole?

    YesNo

    If yes, where and for what?

    Name of Arresting Officer

    Name of Police Department

    Why were you stopped according to the officer?

    Other charges received with this DUI (check all that apply)

    Failure to maintain laneSpeedingFailure to yieldIllegal U-turnRunning red light / stop signOther

    Please specify other charges not listed above

    Was there an accident?

    YesNo

    Was anyone injured?

    YesNo

    Were you stopped at a roadblock?

    YesNo

    Which field sobriety tests were you given? (check all that apply) (required)

    NoneHand held breath testFollow the pen with eyesTouch your noseWalk heel to toeOne-leg standSay the alphabet

    Did you take a breath test?

    YesNo, I refusedNo, It was not offeredUrine TestBlood Test

    If you took the breath test, you should possess a printout of the two samples

    Same One

    Sample Two

    Street or Location where stopped

    Was your car towed?

    YesNo

    Who posted bond?

    I didBonding companyA FriendA Family Member

    How long were you in custody?

    At any time did you ask for your own independent blood, breath, or urine test?

    YesNo

    Please explain your request and results

    Additional brief comments