Consultation Form

 

   

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Free Consultation for DUI Cases

Use this simple form to provide us with information that will help us prepare for your free consultation. The information you are providing via this form shall be treated confidentially and is protected under the Attorney-Client privilege. Once received, we will phone you back at our earliest convenience.

Please note that this form is for DUI cases only. Use these links for other types of cases:
 
 
NOTE: * indicates a required field.
 
Personal Information
Name*
First Last
 
Date of Birth (mm/dd/yyyy)
Address
City, state, zip
Country
Phone*:  
(At least one phone number is required.
Use the format 555-555-5555.)
Home
Work ext.
Mobile 
Fax
E-mail
 
Case Information
Describe what happened.*
Please include the date, time and place.
Was there a car accident with the DUI? Yes    No

Was anyone injured? Yes    No
Who was injured?  

Describe the type of injury(ies).
Do you have a court date?
Where is it and when?
Did you call the DMV for a hearing? Yes    No
When is it? (date/time)  
The hearing is  In person  By telephone
Briefly explain any prior criminal record, arrests, convictions, dates and charges.
Which police department arrived?
Breath results   At the scene  %BAC
At the station %BAC
Do you have any photos, reports, bills, estimates or any other documents?   Yes    No

If yes, please describe what you have.
Were you arrested?   Yes    No

Please provide your booking number and name of the jail.
Amount of bail
Was bail paid? Yes  No
Were any recorded or written statements given or signed during this incident?   Yes    No

If yes, when and to whom?
Were you given a ticket?   Yes    No
Was your drivers license valid during this incident?   Yes    No

If not, when and why was it suspended?
Has your drivers license ever been suspended before this incident?   Yes    No

When and why was it suspended?
Was your car searched?   Yes    No

What was found?
 
Other Details
Are you completing this form on behalf of someone else?   Yes    No

If yes, please provide your contact information.
 
Your Name
First Last
 
Phone Number  ext.
Relationship to Subject
   
How would you pay for fees in this matter?
Check
Credit Card
Cashier's Check/Money Order
Cash
Payment Plan
   
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Other (please indicate):
   

Perez & Perez respects your privacy and does not sell or share your confidential information with any other parties. Read more about our privacy practices in our Privacy Policy.
 
The information provided at this web site by Perez & Perez, including all emails and newsletters, is not intended to be legal advice, and legal representation is subject to additional terms and conditions of a signed contract. To read more about this, please see our Legal Disclaimers.

 

 

1440 N. Harbor Blvd., Ste. 900, Fullerton, CA 92835, Phone: (714) 961-1966, Fax: (714) 961-1972

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