Case Preparation

DWI Client Questionnaire

A medical and physical history built specifically for DWI defense. Dozens of ordinary health conditions change how a breath test reads or how a field sobriety test scores, and the State will not go looking for any of them.

20 to 30 minutes Confidential Forensic review

Start the Questionnaire (214) 225-7117

Before You Start

Why These Questions Matter

Almost none of this looks like a legal question, and that is the point. Acid reflux and GERD, dentures and crowns, diabetes, asthma and an inhaler, a gastric bypass, working around solvents, even a recent vomiting episode can all put alcohol in your mouth or your breath that never came from your bloodstream. A breath machine cannot tell the difference. It reports a number.

Standardized field sobriety tests have their own list. A knee or back injury, an inner-ear problem, a concussion, nystagmus you were born with, corrective lenses, being over 65 or more than 50 pounds overweight: NHTSA itself says these affect the results, and the officer scoring you at the roadside almost certainly did not ask.

Your answers go to a forensic-trained attorney, not to a file. Both of our partners hold the ACS-CHAL Forensic Lawyer-Scientist designation, so what you report here is read against the chromatogram, the calibration records and the arrest video, not just filed with them.

You fill it in

Answer what you can, in one sitting or across a few. Skip anything you would rather say out loud.

An attorney reads it

It goes to the attorney on your case, not into a folder. Anything that changes your defense gets followed up.

We put it to work

What you tell us shapes the mitigation report, the cross-examination, and what we ask the State for.

Your Answers

DWI Client Questionnaire

Confidential · No Obligation

Tell Us About Your Case

Everything you submit is confidential and goes to the attorneys working on your case. Submitting this form does not create an attorney-client relationship on its own.

DWI Client Questionnaire

Your Name

Please complete each question fully and completely

1. When was the last time you were examined by a medical care provider (physician, nurse practitioner, chiropractor, etc.) other than for a scheduled checkup?

2. What was the purpose of the visit?

3. What was the diagnosis?

4. Are you currently under the care of a doctor? If so, for what?

5. Please list all medications taken within 36 hours of your arrest (prescription and non-prescription). Include type, dosage and time you took the medication.

6. Were you warned by your doctor or pharmacist of any side effects?

7. Do you have any physical disability which would cause imperfect balance or any injuries that would cause you to look like you were intoxicated when you are not?

8. Any prior sports injuries? Please describe.

9. Any other injuries? Please describe.

10. Have you ever had a concussion? If so, how long ago?

11. Do you exercise regularly?

12. Do you suffer from any eye diseases or disorders?

13. Have you ever been diagnosed with nystagmus?

14. Were you wearing corrective lenses at the time of your arrest?

15. Do you have any difficulties with coordination or balance?

16. Do you have knee problems?

17. Please describe any prior surgeries.

18. Do you have a learning disability?

19. Do you have dyslexia?

20. Have you ever been diagnosed with an anxiety disorder?

21. Have you ever been diagnosed with ADHD? If so, what medication do you take?

22. Have you ever had meningitis?

23. Have you been diagnosed with GERD?

24. Do you suffer from non-alcoholic steatohepatitis (NASH), fatty liver or any other liver condition/ disease or liver enzyme abnormality?

25. Do you suffer from any sleep disorders?

26. If applicable, how many hours had you worked prior to the arrest?

27. How much sleep had you had in the 24 hours prior to arrest?

28. How much sleep do you normally require each night?

29. Do you work around chemicals and solvents?

30. Do you wear a medicinal patch? (ex. Nicotine, motion sickness, birth control)

31. Do you refinish furniture on a regularly basis?

32. Have you had gastric bypass surgery or lap band surgery?

33. Do you suffer from heart disease?

34. Do you have diabetes? If so, which Type? Take insulin?

35. Do you take aspirin daily?

36. At the time of your arrest were you on an unusual or high protein diet? If so, please describe.

37. Are you of Japanese, American Indian or Eskimo descent?

38. Do you suffer from gum disease?

39. Did you vomit before, during or after your arrest?

40. Do you use an inhaler?

41. Do you have dentures, partials, caps, crowns or a retainer?

42. Do you have lung disease such as asthma, chronic bronchitis or emphysema?

43. Do you suffer from stomach ulcers?

44. Do you have Crohn’s disease?

45. Did you take Ambien within 24 hours of your arrest?

46. Do you take Accutane?

47. Is there anything we have not asked about either you or your arrest that you think we should know?

Prefer to do this with someone? Call (214) 225-7117 and we will walk you through it. Our phones are answered 24 hours a day, every day of the year. See our privacy policy for how we handle what you send.

Your Defense Starts Now

Not a Client Yet?

This questionnaire is for clients we already represent. If you have been arrested and have not spoken to a lawyer yet, start there instead. Tell us what happened and we'll review your options, at no cost and no obligation. Intake answers 24/7, and if your case is one we can take on, we schedule a free consultation with an attorney.

Dallas (HQ)

3300 Oak Lawn Avenue, Suite 700
Dallas, TX 75219

(214) 225-7117

Fort Worth

4500 Airport Freeway, Suite 101
Fort Worth, TX 76117

(817) 631-6522

Waco

605 Austin Avenue, Suite 5
Waco, TX 76701

(254) 735-3588

Allen

1333 W. McDermott Drive, Suite 180
Allen, TX 75013

(972) 848-8828