Case Information Form

You can use the submission form below to have your case information sent to the next available attorney, or the contact form to send an e-mail to a particular attorney.

*Name:       
Street address:   
City:   
State:   
Zip:     
Home phone:   
Cell phone:   
Work phone:   
Fax:   
Date of birth:      (MM-DD-YYYY)
*Email address:         
About the arrest:
Date of arrest:      (MM-DD-YYYY)
Court date on ticket:     (MM-DD-YYYY)
Next court date:      (MM-DD-YYYY)
Arresting agency:   
City of arrest:   
*County of arrest:   
Alleged charges:   
Plea, if applicable:   
 
Were you involved in an accident?
No, I was not involved in an accident
Yes, I was involved in an accident
 If yes, was anyone hurt? (Please provide brief details)
 
 
Did the police officer give you any reasons for stopping you
If so, please note them in the box below.
 
What really happened?
 
Did police administer any field sobriety tests at the time of your arrest?
Pleae check all that apply.
Full alphabet - forwards or backwards
Partial alphabet
Counting
Finger-to-nose
Horizontal gaze nystagmus - watching a pen or light move horizontally
Vertical nystagmus - watching a pen or light move vertically
Walk and turn, or heel-to-toe
I refused to submit to field sobriety tests
I cannot recall if sobriety tests were administered
 
Did police administer breath or blood tests?
Please check all that apply.
I refused to submit to a breath or blood test
I was forced to submit to a blood test
Breath test at the scene of the arrest
Breath test at police station
Blood test at a hospital
 
If police conducted tests, what were the results?
Blood test results:   
Breath test results:   
 
Did you request any additional tests?
No. I did not request additional tests.
Yes, I requested additional tests, but they refused.
Yes, additional tests were conducted;
      the results were:  
 
Do you have any prior charges or convictions?
No. I do not have any prior charges or convictions.
Yes, 1 prior OWI/DUI, but it was more than 10 years ago.
Yes, 1 prior OWI/DUI less than 10 years ago.
Yes, 2 prior charges or convictions
Yes, 3 prior charges or convictions
Yes, 4 prior charges or convictions
Yes, 5 prior charges or convictions
Yes, 6 prior charges or convictions
Yes, 7 prior charges or convictions
 
If you were previously convicted, were you represented by attorney?
Yes, I was represented for all prior convictions
No, I was not represented for any prior conviction
No, I was not represented for at least one prior conviction
 
Do you have a driver's license?
Yes, I have a Wisconsin driver's license
Yes, I have a driver's license from another state
No, I do not have a valid driver's license
 
Were miranda rights read to you?
Yes, miranda rights were read to me
No. Miranda rights were not read to me.
I do not recall whether or not miranda rights were read to me.
 
Do you have an attorney?
No. I do not have an attorney.
I qualify for a public defender, but I want to hire a private attorney.
I do not qualify for a public defender.
I don't know if I qualify for a public defender.
     My annual income is:
I have an attorney.
     My attorney's name is:
 
How would you like to be contacted?
 Email
 Phone
     Fax
 Postal mail
 
Comments:

If you send information via the Internet, please remember that e-mail is not a secure or fully reliable means of communication. If you send time-sensitive information, please call (1-877-749-7858) before the time expires to ensure that your communication was received and understood. In all cases, this website and any forms on it cannot create an attorney-client relationship.



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