NM Criminal Lawyer

(505) 247-8558 Toll Free: 1-877-247-8558

	DWI - DUI Criminal Case

Sending this form DOES NOT establish an attorney/client relationship and you should contact our office and follow up regarding legal fees to hire the firm.

Please fill out the following form:

Or download the PDF form and fax to 505.842.8560

Client name:

Date of Birth:

Phone Number:

Date of incident:

(mm/dd/yy)

Time of incident:

(hh:mm)

Officers:

Charges:

Summary of facts before driving:

What did you eat during the 12-hour period to your arrest?

Please describe any mechanical defects in your car?

Were you involved in an accident?

Accident description:

If there was another vehicle involved, what was the conversation did you had with the driver or passenger of the second or third vehicle?

Road Conditions:

Blacktop	Dirt
Wet	Dry
Pavement

Weather Conditions:

Dark	Light
Foggy	Snow
Hail	Slippery
Drizzle
Normal

Were there any passengers in your vehicle when you were stopped?

List all persons with you while you were drinking and/or driving:

Name:	Phone:	(xxx-xxx-xxxx)
Name:	Phone:	(xxx-xxx-xxxx)
Name:	Phone:	(xxx-xxx-xxxx)
Name:	Phone:	(xxx-xxx-xxxx)
Name:	Phone:	(xxx-xxx-xxxx)

Would these persons be willing to testify?

Where did police officers park in relation to your car?

Were you smoking before or after your contact with police?

Field Sobriety:

Please check off the field tests you were asked to perform?

Eye Nystagmus	Heel Toe/Walk line
Leg Lift	Alphabet
Counting	Touch nose
Fingers	Other

Describe the tests and how you did:

Medical:

Were you under the care of a doctor on the date of arrest or just before?

Please describe your condition & treatment:

Had you seen a dentist within the 24-hour period prior to your arrest?

Describe any physical disability which would affect your walk or balance on this date:

Describe any prescribed or over the counter drugs you were taking (i.e. cold, antihistamines, tranquilizers, weight control, aspirin):

Do you have any of the following conditions?

False Teeth	Diabetes
Heart Disease	Speech problem

List any other medical problems:

Was your stomach upset at any time?

Please describe what time and what it caused:

Physical Condition at time of arrest:

Time started drinking:

(hh:mm)

Time stopped drinking:

(hh:mm)

Describe in detail the number and type of drinks you had prior to your arrest:

Did you consider yourself to be under the influence at the time of your arrest?

Did you have a buzz on or were you feeling the least bit affected by alcohol?

Did the officer read you your rights?

When?

What happened in the squad car and what conversation was there between you and the officers?

Was your car towed?

Did you wait for the tow truck?

How long?

Did the police take you directly to jail?

If no, what route did they take?

Were there any statements given by you or anyone else which might be important?

Was any property taken from your vehicle?

What?

How were you dressed at the time of arrest?

Please describe your footwear:

Soiled or clean clothing?

Do you wear glasses/contacts?

What is the prescription for?

Implied Consent:

Were you advised of your right to contact an attorney before deciding whether to take a breath or blood test?

Were you advised of the right to an independent blood test?

If yes, where is the blood sample and who drew it?

Tests:

Blood:

Breath Score:

Given by:

Time:

If you refused to take the test, what did the officer tell you would happen if you refused?

Please describe any other details of your day, the arrest and booking:

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