DUI Questionnaire

DUI Client Questionnaire

Get the Help You Need From Our Bakersfield DUI Lawyer

This form below is for existing clients. In order to give our team a better idea of the circumstances surrounding your DUI charges and allow us to represent you to the best of our abilities, it is necessary that you answer the designated questions below, both carefully and completely. Please do not rush through the questions, but take your time to provide thorough answers with as much information as possible. If you obtained the information from someone else, please indicate so.

If you are a NEW client seeking representation, please click here.

DUI Questionnaire

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  • Information About the Accident Arrest information (This Incident)

  • Other offense information

    If you were charged with any traffic offenses or crimes other than DUI, give the following information on EACH seperate offense:
  • Offense 1:
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  • Offense 2:
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  • Arrest History

  • Offense 1:
  • Offense 2:
  • Offense 3:
  • Offense 4:
  • Offense 5:
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  • Information about vehicle driven at time of arrest

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  • Policy period at the time of your arrest:
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  • Policy period at the time of your arrest:
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  • If yes please provide:
  • Policy Period from the time of your arrest:
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  • Medical Information

    Often one's medical condition can mimic intoxication and may affect one's performance with the police. Please complete each question fully and completely. An omission can adversely affect the outcome of your case.

    If you have sought medical treatment for any physical or psychological condition, please list them below in chronological order from oldest to most recent. Obtain a copy of these medical records for treatment in the past 10 years and provide me with a copy of those records.

  • Symptom 1:
  • Symptom 2:
  • Symptom 3:
  • Symptom 4:
  • Symptom 5:
  • Symptom 6:
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  • When was the last time you were examined by a medical care provider (physician, nurse, practitioner, chiropractor, etc.) other than for a scheduled checkup?
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  • Were you taking any medication or drugs at the time such as cold pills, aspirin, antihistamines, tranquilizers, weight control pills, etc.?
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  • After having been arrested for an offense such as yours, most people feel "down" or "depressed." That is a natural feeling. If we accept your case, we will do whatever we reasonably can to alleviate your fears, but we are not skilled or trained in the field of psychology. However, it is still important for us to know how you are feeling since your arrest. Please check all the following that apply:
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  • Day of Arrest Vehicle and driving conditions

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  • Weather and Road Conditions (check all that apply):
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  • The Offense

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  • Route Driven
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  • Accident

    (Complete this section ONLY IF an accident of some type has occured in connection with your DUI arrest.)

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  • Roadblocks (Complete this section ONLY if you were arrested at or near a DUI checkpoint)

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  • Evidence Seized

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  • DUI Tests Field sobriety tests

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  • Please describe the following conditions at the scene of the field sobriety tests in as much detail as possible:
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  • Chemical tests in general

  • Tests Offered by Officer:
  • Tests Given by Officer:
  • Tests Refused
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  • Breath test (if applicable)

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  • Blood test (if applicable)

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  • After the Arrest Implied consent

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  • Actions after arrest

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  • Tests Offered by Officer:
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  • Effects of a possible conviction

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Why Choose Middlebrook & Associates?

  • 38 Years of Collective Legal Experience
  • Over 250 DUI Trials Handled - With a 97.4% Success Rate
  • Handled More Than 8,500 DMV Hearings in Kern County
  • Expert Member of California DUI Lawyers Association
  • ACS-CHAL Forensic Lawyer - Scientist Designation
  • AV Rated by martindale.com - Leading Authority on Attorney Ratings
  • Teaches Lawyers & Scientists - DUIDLA, American Academy of Forensic Science & American Chemical Society
  • Founding & Board Member - DUI Defense Lawyers Association (DUIDLA)
  • Top 100 Lawyers in America - DUI Defense

Get Help Immediately

Call (661) 874-1325 or Submit This Form

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Client Testimonials Hear from Real People Who We've Helped
  • “They gave me peace of mind.”
    I am deeply appreciative of the staff at Middlebrook & Associates for their help with my case. They handled everything remotely, provided consistent updates, and significantly reduced the charges. The team is caring and professional. Highly recommend them to ease your worries and achieve the best outcome.
    - Former Client
  • “Excellent at what they do.”
    I was charged with a DUI and an auto accident involving a parked vehicle. Fearing the worst, Middlebrook & Associates worked out a deal I never imagined. I avoided jail time, work release, and an interlock device. Middlebrook & Associates are excellent at what they do; highly recommend them.
    - Anonymous
  • “If I am ever in need of an attorney again, there is no doubt I would hire Mr. Middlebrook's firm.”
    I was arrested for driving under the influence. After meeting with several lawyers, I retained Mr. Middlebrook to represent me. He took the time to listen and his advice and counsel was more than I could have asked for. Not only did he get my case dismissed, his fees were fair too. I have since referred my friend to Mr. Middlebrook and his case was dismissed too. If I am ever in need of an attorney again, there is no doubt I would hire Mr. Middlebrook's firm.
    - J.T.
  • “Very pleased and happy”
    I am very pleased and happy with my results. I’ll be sure to refer him to friends and family.
    - Juan Carlos Sanhez