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Rest assured, this information will be kept
STRICTLY CONFIDENTIAL
DWI/DUI
PROSPECTIVE CLIENT QUESTIONNAIRE |
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| Please fill out this form prior to calling us.
This information will help us better understand your case and you
will have the important information we need to evaluate your case
properly. This information is confidential and
protected under the attorney/client privilege. |
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Contact
Information |
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Name: |
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Address: |
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City, State, Zip: |
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Phone Number: |
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Cell: |
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E-mail: |
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Information About
Prior Problems |
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Have you been convicted of a DWI/DUI in
Louisiana or another jurisdiction in the last ten years? |
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Comments:
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Do you have any other criminal
convictions within the last ten years? |
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If so, please give date and offense.
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Information About
This Arrest |
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Date of this Arrest: |
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Other Charges at the Time of This Arrest:
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Arresting Agency: |
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If Other: |
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Parish of Arrest: |
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Did you take any Field Sobriety Tests? |
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If so, which ones? (Check all
that apply) |
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Horizontal Gaze Nystagmus Test (Pen-light
test) |
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Walk and Turn |
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One Legged Stand |
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Alphabet Test |
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Other test |
(If Other, describe) |
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Did you take the breath test or blow into
the machine? |
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Are you willing, if necessary, to pay for
expert witnesses for your defense? |
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Do you have an occupation that is in
jeopardy if you are convicted of DWI? |
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Thank you for completing this
questionnaire.
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By clicking the submit button below, your
information will automatically be sent to my assistant. We
be in touch to set up a time that is convenient for you to talk about
this within One Working day after receiving this information.
Joe Long, Attorney At Law
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