Drunk Driving Case Evaluation

All Information Submitted to Us is Kept Strictly CONFIDENTIAL

If you are facing a drunk driving charge in Florida, complete the form below and submit it to us, or you can call our office at 941.475.7966.

Be sure to fill in the email address and phone number so that we can contact you. If you don't have an email address just type "none".

Full name (required)
Address 1
Address 2
City
State
ZIP
Phone # (required)
Okay to call you at this number?	Yes No
Alternate Phone#
Okay to call you at this number?	Yes No
Alternate number is a
FAX
Okay to fax you at this number?	Yes No
Email (required)
Okay to email you at this address?	Yes No
How did you find this web site?
Please specify how you found us, if not listed above
Are you mainly interested in fighting your DUI, or do you want to plead guilty?
Date of Arrest
Time of Arrest
Day of the Week
State Where Arrested
City Where Arrested
County Where Arrested
Court Date (leave blank if unsure)
Time of Court
Name of Court
Driver's License #
State Where Licensed
Date of Birth
Is this your first DUI in your lifetime--anywhere, anytime?	Yes No
If you have had prior DUIs please list them below:

Month/Year----State----County----Result (Guilty, Not Guilty, Nolle, Stet, PBJ)

Are you currently on probation or parole?	Yes No
If "yes", where?
Other Tickets/Charges received with this DUI (check all that apply):	Failure to Maintain Lane Speeding Illegal U-Turn Running Red Light Defective Equipment No Proof of Insurance Failure to Yield Other (Please specify below...)

Please specify other charges not listed above

Why were you stopped/arrested, according to officer?

Was there an accident?	Yes No Not Sure
Was anyone injured? (check all that apply):	No one was hurt/Not applicable Myself Passenger(s) in my vehicle Passenger(s) in another vehicle Pedestrian Not Sure
Were you stopped at a roadblock?	Yes No
Were you given field sobriety tests at the location where you were stopped?	Yes No Don't recall Refused
Which field sobriety tests were you given? (Check all that apply)	Handheld Breath Test Walk-and-turn 9 steps heel to toe One-Leg Stand Follow-the-Pen-With-Eyes Say the Alphabet Touch Your Nose Other (Please specify below...)
Please specify other tests you took, that are not listed above
Describe how you think you performed on each of the tests
Do you have any medical conditions or injuries that could have affected affected your eyesight or balance? If the answer is yes, provide some details.
Did you take a breath test?	Yes No, I Refused No, Test Was Not Offered to Me No, I Was Given a Blood Test Not Sure

WARNING: IF YOU WERE CHARGED WITH REFUSING THE TEST YOU FACE AN AUTOMATIC SUSPENSION OF YOUR LICENSE FOR 120 DAYS, FOR A FIRST REFUSAL OR ONE YEAR FOR A SUBSEQUENT REFUSAL. IF A JUDGE FINDS YOU REFUSED YOU MAY ONLY BE ABLE TO MAINTAIN DRIVING PRIVILEGES IF YOU PAY TO INSTALL AND MAINTAIN AN INTERLOCK DEVICE IN YOUR CAR FOR ONE YEAR.

YOU HAVE 10 DAYS FROM THE DATE OF YOUR ARREST TO FILE A REQUEST FOR A HEARING WITH THE OFFICE OF ADMINISTRATIVE HEARINGS TO CONTEST THIS SANCTION AND GUARANTEE THE HEARING WILL BE HELD BEFORE YOU LOSE ANY DRIVING PRIVILEGES. THE ABSOLUTE DEADLINE FOR REQUESTING A HEARING IS 30 DAYS.

LIKEWISE, IF YOU SUBMITTED TO A TEST WHICH YIELDS A RESULT OF 0.08 GRAMS OR MORE, YOU CAN ALSO BE SUSPENDED FOR 45 DAYS FOR A FIRST OFFENSE OR 90 DAYS FOR A SUBSEQUENT OFFENSE.

CALL OUR OFFICE IMMEDIATELY FOR ASSISTANCE!

If you took a breath test you should have a print out of the two test samples. List your breath test results here:	Sample #1 Sample #2
Blood test results	Check here if test results are pending
If your test result was .08 or more or the officer claims you refused the test, check here if you have not yet requested an administrative hearing.
Were you released by the police officer or held and taken to a commissioner.	Released Held and taken to a commissioner
If you were held what date (if different) and time were you released.
Name of police department
Street or location where stopped
County where stopped
Was your car towed?	Yes No
Who called the tow truck?	I Did Officer Did Not Sure
Who posted bond?	I Did Bonding Company Family Member/Friend Other
Were there any witnesses with you who could testify for you?	Yes No
At any time during your arrest did you ever ask for or inquire about getting your own independent blood, breath or urine test?	Yes No
Did you get an independent blood, breath or urine test?	Yes No
If "yes", what was the result?	Check here if test results are pending
Did you ever ask to call an attorney?	Yes No
If "yes", when (give details)?

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