Consultation Form

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For immediate assistance seven days a week, call (714) 961-1966.

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