Kansas City Law Firm | Angles Law Firm Logo1609 West 92nd Street, Kansas City, Missouri 64114

Phone (816)471-5777 | Fax (816)471-5778

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DUI Client Questionnaire

    Basic Information

    Ok to use

    Do you have a Commercial Driver’s License (CDL)?

    Have you had driver’s licenses in other states?

    How were you referred to the Angles Law Firm, LLC?

    What is your preferred method of payment?

    DUI/DWI Information

    Details win DUI cases. The only way to have a viable chance at being successful in your case is if
    we know as much detail as possible on the following questions. If you don’t know the answer to a question, leave it blank or indicate so. Please be assured that this questionnaire will be used in our office only, and your confidentiality will be protected.

    Have you ever been arrested for a DUI or DWI before?

    For each arrest list the approximate date and the outcome of the case
    (including pending cases, diversions, dismissals, convictions, etc.)

    Please list all prior arrests of any kind, including the approximate date of diversion, conviction, or dismissal
    (also, please list any pending cases)

    Were you on diversion or probation at the time of your arrest in this matter?

    Arrested by

    Were you involved in an accident?

    Was anyone injured?

    Did the officer ask you to take field sobriety tests?

    Did the officer have you follow a pen or other instrument with your eyes?

    Did you...

    Did the officer have you stand on one leg?

    Did you...

    Did the officer have you walk a line heel-to-toe?

    Did you...

    Did the officer have you say the alphabet?

    Did the officer have you count numbers?


    Did the officer have you blow into a hand-held breath machine?

    Did the officer tell you that you could refuse to blow into that machine?

    Were you handcuffed?

    Did the officer ever read you your rights
    (i.e the right to remain silent, anything you say could be used against you, right to an attorney)?

    Did the officer ever read you a list of rights about chemical testing to determine your blood or breath alcohol

    Did the officer make you wait 15-20 minutes before taking the test?

    Did the officer ever leave you alone during this 15-20 minute period?

    Did you cough, belch, regurgitate or put anything in your mouth during this 15-20 minute period?

    Did you submit to a test of your

    Did you ask the officer if you could take a test other than the test offered?

    If you refused, did you tell the officer why you refused?

    Did the officer ever look inside your mouth?

    Did you have anything inside your mouth?

    Do you have gum disease or problems with bleeding in your mouth?

    Were you wearing contacts at the time of arrest?

    Have you ever had surgery?

    Do you work around any solvents or chemicals (i.e. paint, paint thinner, gasoline, etc)?

    Do you suffer from acid reflux, GERD, or other similar problems?

    Do you use your car during the course of your employment?