DUI Questionnaire If you do not forward this information to our office, be prepared to give this information over the phone. Arrest Information Date of arrest: Time of arrest: City and state of arrest: Exact location of arrest ( i.e. intersection of Sahara and Las Vegas Blvd ) Arresting agency: Why were you stopped? Do you have any physical limitations that would hinder your ability to take the field sobriety tests? YesNo Which field sobriety tests did you take? Please check all that apply. Horizontal Gaze Nystagmus One Leg Stand Walk and Turn Finger Counting How do you feel you did on these tests? Please elaborate. Did you take a blood or breath test, or did you refuse all chemical testing? Please check all that apply. Blood Test Breath Test On Scene Breath Test Other Location Refused All Tests Except Breath On Scene Refused All Tests What were the results of these tests? Were you advised that you had a right to refuse the breath test? YesNo Were you advised that if you refused that you would lose your license for period of time if you had priors? YesNo Were you advised that there was mandatory jail time if you refused and were convicted? YesNo Were you advised that your refusal could be used against you in court? YesNo Did the officer confuse you in any way? YesNo What county and court is your case in? When are you to appear? Have you ever been arrested for any other alcohol or drug offenses? Valid Nevada Driver’s License Number Out-of-State Driver’s License Number Confiscated License? YesNo Was your vehicle impounded? YesNo Did you post bail? YesNo Bail Amount Biographical Information What is your name? What is your address? List the phone numbers where you can be contacted. Can messages be left at these numbers? YesNo What is you email address? Age Sex MaleFemale Weight Occupation License necessary for employment? Please enter the characters seen below: In addition to clicking the "Submit" button above, please copy and paste this information in an e-mail to The Law Office of Garrett T. Ogata Call (702) 366-0891 for a free consultation.