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Evaluation Request
D.A. Wynne & Associates, Inc.
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* Indicates required question
Full Name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Home address
Your answer
Phone number
*
Your answer
Email address
Your answer
Type of arrest
*
DUI
DWI
Possession
Assault
Other:
BAC level (if applicable)
*
Your answer
How many times have you ever been pulled over for driving under the influence of alcohol and or drugs?
*
0
1 (this is my first DUI)
2
3
4
5
6
7
8
What county did the offense happen in?
*
Your answer
Referral Source
Choose
Attorney
Probation
Court
Friend
Mailing
IPSA
VASAP
Other
Who is your lawyer?
Your answer
Who is your probation officer?
Your answer
What would be the best time to contact you
*
Morning
Afternoon
Evening
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