time Email
  • POTENTIAL CLIENT QUESTIONNAIRE

  • PERSONAL INFORMATION SECTION

  • Required Required

  • Required Required Required Required

  • (Ex: 3 Children - Age 4. Age 8, Age 10)

  • CURRENT ARREST INFORMATION

  • Ex: Officer Joshua Ott, Badge 038

  • Ex: State Court of Cobb County

  • Should be on citation or bond paperwork

  • Ex: Holcomb Bridge Road near Warsaw Road

  • Results are usually located on the Intoxylizer 9000 Report (Subject Sample)

  • Enter total amount of bond - if multiple bonds enter total for all charges

  • If cash bond- who was surety? If you used bonding company - what company?

  • Ex: Pam Jones - 404-666-5455, Tim Jones - 404-332-3233

  • EMPLOYER INFORMATION

  • MEDICAL/HEALTH INFORMATION

  • Enter medication name, dosage, and time taken. Separate medications with a comma

  • Please tell us what you took, how much you took, and when you took it

  • PRIOR CRIMINAL HISTORY

  • Ex: 06-2002 Arrested for DUI Glynn County - Case reduced to Reckless Driving

  • RIGHT TO COUNSEL

  • EVENTS OF THE DAY - VERY IMPORTANT (Do Not Skip)

  • Tell us who you were with, where you went, what you ate, what you had to drink, at what times drinks were consumed, size of drinks, what happened when the police encountered you, what police had you do, etc.

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