Please type the name of the driver who was arrested If you are not the driver, please type your name and relationship here 1. Did the officer see you driving the truck/car? Yes No Not sure 2. Why did the officer contact you? Speeding Weaving Accident - no injuries Accident - injuries Great bodily harm Vehicular homicide Roadblock I don't know Other 3. Check if the officer took your license or gave you a paper called Temporary Driver License 4. Have you contacted MVD to request a hearing Yes No 5. What date and time were you arrested by the officer? 6. About how many minutes from when you were arrested (put in handcuffs) until when you arrived whever you took the breath/chemical test 7. How many drinks did you have? Many people under-estimate how many drinks they had, or cannot remember. One drink is equal to a 12 ounce beer, a glass of wine, or a shot of hard liquor Did not drink Don't Know 1 2 3 4 5 6 7-12 > 12! 8. When did you finish your LAST drink? 9. What time did you tell the officer you had your last drink? 10. If you were on prescription medication or other drug, what type? None Not applicable Over the counter meds Prescription pain meds Anti-depressant Valium/tranquilizer Marijuana Cocaine Other illegal substance Discuss in person 11. Please type the name of the drug, how much and when you last took it 12. When had you eaten before the arrest? What did you have? 13. BALANCE TEST CHECKLIST. Check if you performed any coordination or balance tests before your arrest. ------- Did not take any field tests ------- Follow a pen, finger, or other object with eyes -------Standing with head titled back and eyes closed, feet together -------Standing on one foot for a period of time -------Patting your hands together -------Counting on your fingers -------Saying or writing the ABCs -------Walking a straight line, or heel-to-toe -------Touching your nose with finger -------I don't know -------Other (please describe what) -------Not applicable (explain briefly why not) 14. Did you fail your balance and coordination tests? How so? 15. Check box if you blew into a portable field breathalyzer 16. What was the result of the field breathalyzer 17. Did the officer explain that you could refuse the field breathalyzer? Yes No I don't know Not Applicable 18. What type of chemical test did you take? Breath Blood Both Urine No Chemical Test I don't know Not applicable 19. What were the results of the test, if you know? 20. If you are charged with refusing a chemical test, please explain what happened 21. For the breath test, did the officer wait 15 minutes before your first breath into the Intoxilyzer 500? Yes No I don't know Not applicable 22. Which law enforcement agency arrested you? New Mexico State Police County sheriff City police Tribal police Other agency Don't know Not applicable 23. Describe any other charges during your arrest 24. Please type the arresting officer's last name and badge number 25. You were arrested in which city/county? 26. BAIL. Check if the defendant is still in jail -------Check if you hired a bondsman to secure your release from jail -------Check if you posted money directly with the court or law enforcement agency 27. How much did you pay the bondsman or post with the court? If the defendant is still in jail, what amount did the court set for bond? 28. What is your budget for a lawyer to represent you in court? 29. The attorney will expect to be paid before the final court hearing. How much can you pay up front, and how much can you afford to pay each month until paid in full? 30. What goals do you have in your DUI case? For examples: stay out of prison/little/no jail time/ankle bracelet/limited driving privilege/affording car insurance 31. When is your next court date? 32. CONTACT INFORMATION. Your mailing address -------City -------State -------Zip Code -------Home Phone (include area code only if long-distance from Santa Fe) -------Work Phone Cell Phone Pager Fax Number Email address 33. Contact Instructions. Please set forth the best way to contact you How did you learn about us? Check box if you have contacted another DUI attorney Date of Birth How many prior arrests do you have for DUI? 0 1 2 3 4 or more In approximately what years were your prior DUI arrests? Check if you already have a copy of the police report in this case Check if you have a notice of hearing or other court pleading which you can fax to our office (984-1110) Occupation Place of Employment If you are not employed, do you have someone who can co-sign your fee agreement? Check if you have ARAG or other legal insurance Let us know any other facts about you or your case that you need to tell your lawyer
