After the Arrest

Implied consent

Were you told that if you refused the test, your license would be revoked, suspended , or canceled?
At the time of the warning, had you been told that you were under arrest?
Were you advised that you could contact an attorney before deciding to submit to a test?
Were you refused the opportunity to consult with a lawyer before deciding to take the test?
Were you advised that after the officer's test you could take another test by medical personnel of your own choosing?
At the time that you refused the State's test(s), had the officer(s) done anything to frighten you or said or done anything to offend you to such a degree that you were unwilling to cooperate with the police?
Were you suffering any pain, discomfort or other physical or mental impairment which would have justified your refusal of (or explained your refusal of) the State's test(s)?

Actions after arrest

Were you handcuffed?
Did that make you angry?
Did you ask not to be handcuffed?
Did the handcuffs hurt?
Were you handcuffed in front of other people?
Did you suffer any numbness, pain or discomfort in your hands or arms?
Did you complain of pain from handcuffs?
Have you sought medical aid about the problem?
Did you overhear any radio transmissions to or from the officer while he/she was driving you to the testing site/jail/hospital?
Did you ask the transporting officer any questions during the trip?
Did you ask to go to a rest room?
Did the officer accompany you?
Were you cooperative with the officer?
Weather and Road Conditions (check all that apply):
Is the bonding company paid in full?


Police Report

Effects of a possible conviction

Do you ever have to prove "insurability" in order to drive a "company" car?
Do you ever need to rent a rental car, for personal or business use?
If so, would denial of access to rental vehicles affect you or your employment?
Are you involved in any "domestic" (divorce, child custody, etc.) case or judicial dispute that a DUI conviction might affect?
Are you professionally licensed (i.e., teacher, attorney) or specially licensed (i.e., pilot, cab driver, etc.) such that you may lose such license as a result of a conviction?
Does your job involve "security clearance" or "top secret" status such that your employer may be unwilling to accept a DUI conviction?
Are you currently enrolled in college or university, where you may be subject to disciplinary suspension for DUI?
Do you have a student loan which may be adversely affected by a DUI conviction?
Are you presently in military/reserves or planning to join military/reserves?
If your license is issued by another state, are you aware that there may be additional penalties and/or insurance assessments if convicted in this state?
If you have not done so already, would you like to hire a lawyer in your home state with whom we may confer?
We recommend doing so. We are not licensed to practice law in your home state and therefore are not familiar with all the laws and consequesnces that might affect you.

Please use the space below and on the back, to give me any other information you may think be important.

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