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DUI Case Information

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What follows is a confidential, standard DUI questionnaire designed to assist our firm in evaluating your case. We understand that this information may, at first, appear to be unnecessary, or personally intrusive. However, medical issues, prescription medications, and physical abilities play an important role in any DUI investigation. The information provided will help your attorney determine if any issues exists and how best to use them during the course of your case.

This form is completely optional and voluntary. If you do not wish to complete this form or disclose this information, you are not required to do so. If you have any questions, please call our office at (602) 833-4548.

  • Do you have or have you ever been diagnosed with any of the following medical conditions? Please check box if yes.
  • If you selected yes to any of the conditions above, please add any additional known details regarding your condition including date of diagnosis and current treatment requirements, if any.
  • Have you been treated by a doctor or a dentist in the last 6 months?
  • If you selected yes to any of the conditions above, please add any additional known details regarding your condition including date of diagnosis and current treatment requirements, if any, including prescription or non-prescription medication or supplements.
    At the time of your stop, were you:
  • Do any of the following apply to you - are you concerned about keeping or obtaining any of the following?
  • Corrective lenses, interlock, work restrictions, etc.
  • Did the police tell you what any of your tests results were (aside from the paperwork)?
  • This field is for validation purposes and should be left unchanged.