Client Information and Intake Form



Check all that apply: *











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Have you Received any Tickets in the Last 2 Years? *
Have you have ever been Previously Charged or Sentenced for DUI, Leaving the Scene of an Accident or DWLS? *

*** Only Complete if Cited for Criminal Violations ***

Are you currently on (check all that apply):




Are you out on a Cash Bond?
Are you out on a Surety Bond?

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All fields are required. Form use does not create an attorney-client relationship

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