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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  • Please enter your Job Occupation.
  • Please enter your Date of Birth.
  • Please enter your Social Security Number.
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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:
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  • 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:
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  • 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

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Client Testimonials Hear from Real People Who We've Helped
  • “We are very grateful to Mr. Middlebrook for his extremely professional handling of our daughter’s case”
    By way of background, I am a civil trial lawyer who practices law in another state. In 2020, after a questionable traffic stop, my daughter was arrested for DUI. Our family engaged Mr. Middlebrook to assist her. After he reviewed the evidence, Mr. Middlebrook identified the weaknesses in the State’s case and formulated a trial strategy to include the retention of an appropriate expert witness. While waiting for trial, Mr. Middlebrook prevailed in the administrative proceeding allowing my daughter to retain her driver’s license pending trial. After plea negotiations fell through, we went to trial on the criminal case. I have over 35 years of experience in a courtroom and have tried dozens of cases to verdict. On the first day of trial, I could tell that Mr. Middlebrook had the respect of the trial judge and the prosecutor. He developed an excellent rapport with the jury. In his examination of the expert witnesses for each side, Mr. Middlebrook demonstrated a deep understanding of the science related to DUI cases. His cross-examination of the arresting officer was respectful while making the officer appear to be, at best, incompetent in his handling of the stop and administration of the breathalyzer test. The jury acquitted my daughter on one charge and deadlocked on the other. An acceptable plea agreement on the remaining charge was thereafter reached allowing for all charges to eventually be dismissed and expunged from her record. We are very grateful to Mr. Middlebrook for his extremely professional handling of our daughter’s case, and I highly recommend him.
    - Ken I.
  • “No words to describe the teams professionalism”
    I was arrested for a first time DUI on December of 2015. I went to Mr. Middlebrooks's office the very next day and explained my case. He gave me a step by step overview of what is going to happen. It would be a shame on my part if I didn't review his teams work for me. I was updated promptly and they basically took over the entire area and only called me once or twice where I was actually needed with my case. After 6 months of deliberation, he managed to get my case thrown out due to technicalities and all charges were dropped against me. My greatest gratitude goes to his entire team. I've had sleepless nights over my arrest and how my future was going to be permanently affected if I had been convicted. After researching, I noted that he actually charges a bit more than the average for a DUI attorney in town, but I have absolutely no regrets whatsoever with his service and I would not hold back from recommending his office to anyone. I truly appreciate his teams commitment to quality of work they have done.
    - Gabriel
  • “From the moment you walk into the office the staff is gracious and accommodating.”
    From the moment you walk into the office the staff is gracious and accommodating. They do their best to make you feel like they actually care about you and your case. Mr. Middlebrook is very knowledgeable and takes the time to answer all your questions. If you are looking for a caring, hard working and knowledgeable attorney I would highly recommend The Law Office of Richard O. Middlebrook.
    - Name Withheld
  • “Richard provided very knowledgeable advice and counsel, and, in fact, every court action played out exactly as he anticipated.”
    Of course he knew the law and the precedents, but more importantly he knows the court, the judges and commissioners, and the other attorneys involved. His greatest value was in knowing how this particular court (Kern County Superior Court - family law division) works, the main players involved, and anticipating each player's actions and responses. No one can tell you for sure what will happen in court, but Richard provided very knowledgeable advice and counsel, and, in fact, every court action played out exactly as he anticipated. He was a little more expensive (in terms of hourly rate) than the other attorneys I interviewed, but he was worth it because he got me exactly what I wanted.
    - Katie T.