DUI Questionnaire

Name*
Email*
Did the officer see you driving?
- Yes
- No
Did you admit to driving the vehicle?
- Yes
- No
Did the officer have a valid and legal reason for stopping you or contacting you in/near the vehicle?
- Yes
- No
Did you admit to drinking or doing drugs?
- Yes
- No
Did you take any field balance and coordination exercises before arrest and handcuffing? (i.e. standing on one foot, walking a straight line, etc.)
- Yes
- No
Did the officer tell you that you could refuse to take the hand-held field breath test?
- Yes
- No
Did you fail to satisfactorily perform the balance and coordination tests as demonstrated to you by the officer?
- Yes
- No
Did you take a blood, breath, urine or saliva test within 1 1/2 hours after finishing your last drink of alcohol?
- Yes
- No
Did you choose the blood, breath, urine or saliva test that you took?
- Yes
- No
Were your test results greater than .12%?
- Yes
- No
If you are charged with refusing to take a blood, breath, urine, or saliva test, did you refuse to take a test after being told that your license would be suspended or revoked, or that it would be a crime to refuse, if you refused?
- Yes
- No
Did you voluntarily take the blood test?
- Yes
- No
Did the breath test machine operator watch you closely for at least 15 minutes (20 minutes is recommended) before your first breath into each of the breath machines?
- Yes
- No
Did the breath test machine operator check to make sure you didn't burp, belch vomit or have anything in your mouth prior to the test?
- Yes
- No
Did you blow into the breath test machine only two(2) times?
- Yes
- No
Were the results within .02% of another?
- Yes
- No
After completing the breath test,did the officer/operator tell you that the breath test machine destroys your breath sample and therefore, you had the additional right to take a blood or urine test free of charge?
- Yes
- No
If you took the urine test, did you completely empty your bladder the first time you urinated?
- Yes
- No
Did the officer collect your urine twice?
- Yes
- No
Was the officer with you when you provided both urine samples?
- Yes
- No
Did you drink any alcoholic bevarages, or take any drugs within 5-10 hours of being stopped by the officer?
- Yes
- No
Did you feel the effects of the alcohol or drugs (i.e. feel a buzz, feel drunk or high, unable to drive)?
- Yes
- No
Did the officer treat you fairly and professionally?
- Yes
- No
Facts about the arrest:
Any additional comments: