FREE Case Review

For a FREE Case Review, please complete and submit the form below.  There is NO COST and NO OBLIGATION.

By clicking the "Send" button below and submitting this FREE Case Review request, you understand and agree that your case may be reviewed by attorney(s) and law office staff who may contact you about this matter, and that your submission of information in no way creates or constitutes an attorney-client relationship. You also acknowledge that any information transmitted electronically by your FREE Case Review request may not be secure, may not be protected by attorney-client privilege, and might be viewed by other parties.

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Required Information

First Name *
Last Name *
Phone *  -  -
Okay to call you at this number? * Yes No
Email address *
Okay to e-mail you at this address? * Yes No
Address 1 *
Address 2 *
City *
State *
Zip *
Okay to mail you at this address? * Yes No

Additional Information

Alternate Phone  -  -
Okay to call you at this number? Yes No
Alternate Number is a: Pager Cellular Family Member/Friend Business Other
Fax  -  -
Okay to fax you at this number? Yes No
Please specify how you found us
Are you mainly interested in fighting your DWI, or do you want to plead nolo or guilty? Fight the Case Plead Nolo Plead Guilty Not Sure
Date of Arrest
Time of Arrest
Day of the Week
City Where Arrested
Parish Where Arrested
Court Date
(leave blank if unsure)
Time of Court
Name of Court
Driver's License Number
State where Licensed
Date of Birth
Is this your first DWI / DUI in your lifetime -- anywhere, anytime? Yes No
If you have had prior DWIs / DUIs please list them below
Month / Year -- Court -- Result (Guilty, Not Guilty, Nolo)
Are you currently on probation or parole? Yes No
If "yes", where?
If "yes", for what offense(s)?

Other Tickets / Chargest Received with this DWI (check all that apply):

Improper Lane Usage
Illegal U-Turn
Running Red Light or Stop Sign
Defective Equipment
No Proof of Insurance
Failure to Yield
Other (please specify)
Other (please specify)
Other (please specify)
Why were you stopped / arrested, according to the officer?
Was there an accident? Yes No Not Sure

Was anyone injured? (check all that apply):

No One Was Hurt / Not Applicable
Passenger(s) in My Vehicle
Passenger(s) in Another Vehicle
Not Sure
Were you stopped at a roadblock (DWI checkpoint)? Yes No Don't Know
Were you given field sobriety tests at the location where you were stopped? Yes No Don't Recall I Refused

Which field sobriety tests were you given? (check all that apply):

Hand Held Breath Test
Walking Heel to Toe
One-Leg Stand
Say the Alphabet
Touch Your Nose
Other (please specify)
Other (please specify)
Other (please specify)
Did the officer advise you that field tests were 100% optional and that no penalty would result from not doing them? Yes No Not Sure
Were you videotaped at any point during your arrest? Yes No Not Sure
Did you take breath test? Yes No, I Refused Not Sure

WARNING: If you refused or Failed the breath test, you could face an automatic suspension of your driver's license. You may have only 15 days from the date of your arrest to request a hearing to challenge the suspension of your driving privileges. Call our office immediately for assistance at (985)370-9832.

If you took a breath test you should possess a print-out of your test samples. List your breath test results here:

Sample #1
Name of Testing Officer
Name of Arresting Officer
Name of Police Department
Street or Location Where Stopped
Parish Where Stopped
Was Your Car Towed? Yes No
Who Authorized the Tow Truck? I Did Officer Did Not Sure
Who Posted Bond? I Did Bonding Company Family Member/Friend Other
Amount of Bond $
Were there any witnesses with you who could testify for you? Yes No
If "Yes", Give Names and Contact Info
At any time during your arrest did you ever ask for or inquire about getting your own independent blood test? Yes No
Did You Get an Independent Blood, Breath, or Urine Test? Yes No
If "Yes", What were the results?
Check here if test results are pending
Did You Ever Ask to Call an Attorney? Yes No
If "Yes", when? (give details)

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Would you like a FREE copy of DWI Handbook? Yes No
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