New Client E-Mail Questionnaire For Los Angeles, Orange and Ventura County Arrests
The following information is subject to the attorney-client privilege. I will use this information to contact you to setup an appointment to schedule a free initial office consultation.
Today's Date :
Your Name :
Your Address :
Home Phone :
Business Phone:
E-Mail Address:
Contact Preference :
Date of Birth :
Occupation :
Annual Income :
Place of Employment :
Date of Your Arrest?:
City and State where arrest took place? :
Scheduled to appear in which court? :
When :
Did you take a blood, breath or urine test? Yes No
If 'yes' what were the results :
Have you ever been arrested for DUI before? Yes No
If 'yes' When? :
Have you contacted the DMV? : Yes No
Have you consulted with another attorney? : Yes No
Is it your goal to win your DUI case? : Yes No
Is it your goal to have the DMV suspension/revocation set aside? : Yes No
Are you aware that most DUI cases can be successfully defended? : Yes No
Are you aware that a conviction and/or driver's license suspension for DUI will result in
insurance cancellation or an increase cost between $15,000 to $25,000
during the next seven years? : Yes No
What is your budget to defend this case? :
I hereby give the Law Offices of Myles L. Berman permission to use my case
to be added to the "Partial List of Successful DUI Cases"
should my case be successfuly concluded : Yes No