Connectucut DUI Lawyer and Drunk Driving Defense Information

Client Contact Form

Dear Attorney Tomeo,

I would like to discuss my case with you. I enclose the following information:

Name:
Address:
City:
State:	Zip Code:
Date of Birth:
Phone:
Speak Only With:
*eMail Address:

Date of Stop:
Time of Stop:
Town of Stop:
Where were you stopped?
Yes     No Were you driving?
Yes     No Were you given the Standard Field Sobriety Tests?
Yes     No Were you arrested?
Yes     No Did the police officer observe you driving?
Yes     No Were you involved in an accident?
Breath Blood Urine Did you take either a breath, blood or urine test?
If You Took a Breath Test, State the Following:
Time of first test?
Result of first test?
Time of second test?
Result of second test?
Yes     No Were more than two (2) tests given to you?
Yes     No Were drugs involved, i.e. marijuana, heroin, cocaine, etc.?
Yes     No Were you charged with driving under the influence of alcohol and or drugs?
Yes     No Were you charged with any other motor vehicles or criminal charges?
State the name of the police department the arresting officer was from.
State the name and badge number of the arresting officer.
Yes     No Was it the arresting officer who gave you the breath, blood or urine test?
Yes     No Have you ever had the Alcohol Education Program in Connecticut or any other State within the past ten (10) years?
If yes, where?
Yes     No Have you ever been convicted of driving under the influence of alcohol and or drugs in Connecticut or any other State?
If yes, list the name of the State(s), the date(s) of each charge:
Additional Comments: