Joseph Waldbaum, ESQ. Massachusetts OUI, DUI, DWI
Drunk Driving
Defense Lawyer
Free Consult 24/7
978.921.4100
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OUI Questionnaire

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USE TAB KEY TO REACH NEXT QUESTION
 
1. Name (first and last):
 
2. Date of birth:
 
3. Place of birth:
 
3a. U.S. Citizen?

 
4. If a Veteran, give details:
 
5. Home Address (including city/state):
 
6. Own or Rent?
 
7. How long at that address?
 
8. Home Phone Number:
 
9. Other Phone Number:
 
10. Please Call Me At:
 
11. Social Security Number (no dashes) (optional if not yet a client):
 
12. Your Email Address:
 
13. Date and Time of Arrest:
 
14. Next Court Appearance Date:
 
15. OUI Offense (1st, 2nd, etc.) In Your Lifetime:
 
16. Other charges you are facing in this current incident:
 
17. Court Handling Case (Full Name):
 
17a. Docket Number of case [if known -see upper right corner of Complaint]
 
18. Alleged Breath Test Reading. Indicate if test was refused.
 
19. Which police department arrested you?
 
20. Please describe your desired outcome of the case.
 
21. We don't want to schedule court dates that interfere with your life.
Do you have any trips out of state currently planned? If so, where and what dates?
 

1. BASIC
 

1. How were you referred to (or how did you learn about) our office:
 
1b. What media were you using?
 
2. What search term did you use to locate attorney Waldbaum if any?
 
3. If you watched the videos, which one?
 
Were they helpful?
 
How so?
 
4. What factors weighed most heavily in your decision to hire attorney Waldbaum?
 
5. Did you contact any former clients?
 
By:
 
If so, which ones and what advice did they give you?
 
5a. Did you View the E-book entitled “OUI Mistakes to Avoid?
 
Was it helpful?
 
How so?
 
6. Family Status (married, single, etc):
 
6a. If married, do you have more than one car?
 
7. Does Anyone in Your Household Know?
 
8. Dependent Children:
    Names and Ages:

2. LICENSE
 
1. Driver's License Number and State:
 
2. Driver's License Expiration Date:
 
3. Year/Make/Model of vehicle you were driving:
 
4. Possess a Commercial Driver's License (CDL):
 

3. EMPLOYMENT
 
1. Employer and Employer's Address:
 
2. Job Title, and how long:
 
3. Prior Employment (past 5 years) and How Long at Each Job:
 
4. Educational Background:
Highest Educational Level Completed:
 
Name of Institution:
 
5. Vehicle Required for Employment:
 
6. Would you be fired, restricted in duties, passed over for promotion, or demoted if:
(select all that apply)

: Convicted of DUI
: Your License is Suspended
: Suspended with Work Permit
 
7. Do You Drive a Company-Owned Vehicle:
 
8. How Many Miles Driven to/from/at Work on a Routine Day:
 
9. Is Public Transportation Readily Available to You:
 

4. HEALTH
 
1. Height and Weight at Time of Arrest:
 
2. List Any Current or Past Conditions that Might Affect your Balance or Coordination:
 
3. List Any Current or Past Problems With your Arms, Legs, Knees, Ankles, or Feet:
 
4. List Any Prescribed Medication Taken by you Daily or Periodically:
 
5. List Any Non-Prescription Medication Taken by you Daily or Periodically:
 
6. List Any Specific Health Problems:
 
7. List any Denture or Bridgework you May Have:
 
8. Do Have any Stomach Disorders Such as Acid Reflux or GERD:
 
9. Have you ever been diagnosed with ADD or ADHD?
 
10. Do you take medication for it?
 
11. Had you taken the medication on the day of your arrest and if so when?
 

5. EFFECTS OF A POSSIBLE CONVICTION
 
1. What effect would a conviction have on your marriage or job?
 
2. Do you have a Firearms ID card?
 
3. Do you have a License to Carry?
 

6. OTHER ATTORNEYS
 
1. Prior to coming to me for legal assistance, did you consult with
any other attorney(s) about the present OUI case If so, with whom?
 
2. Do you understand that you are free to follow that attorney's advice
(or any other attorney's advice), and that you are in no waybound to use
my legal services in your case unless you hire me?
 

 

7. HOSPITAL
 
1. Were you taken to the hospital?
 
2. Which one? (Name, address, town)
 
3. How long were you there?
 
4. Did the police accompany you?
 
5. Did the police ask you to give blood?
 
6. Did the hospital personnel ask you to give blood?
 
7. Was blood taken?
 
8. How do you know?
 
9. Were you told what the blood alcohol reading was?
 
10. If so, what were you told?
 
11. Did you object to blood being drawn?
 

 

8. EVENTS OF THE DAY OF ARREST
 
1. During the 24-hour period just prior to your arrest, describe your activities IN
GREAT DETAIL from the time you woke up until arrest occurred (list them in
chronological order). Tell me who you were with, what you drank, at what time the
drinks were consumed, what size drinks you had, etc.
 
2. With whom did you talk to within the last 3 hours before arrest?
Include their Name, Address/Phone, Relationship, Employer.
 
3. Was anyone with you when you were arrested?
If so, please list their name, address, home and work phone:
 
4. What was his/her condition (sober, drinking, impaired, passed out, etc.)?
 
5. Did anyone (including the above-named person) observe or overhear any portion or
aspect of the police "stop" or arrest? If so, list their names, addresses, and telephone numbers.
 
6. Please describe the traffic conditions you encountered on roadways prior to being
arrested. Include stop lights (how many and whether they were working properly),
caution lights, weather conditions (be specific).
 
7. Town stopped in:
 
8. Street stopped on:
 
9. Was arrest at roadblock?
 
10. How many police cars did you see?
 
11. Did any have their blue lights on? If so, how many?
 
12. How many police officers did you see?
 

9. DRIVER'S LICENSE AND INITIAL QUESTIONING BY THE OFFICER
 
1. Where was your license when you first began looking for it?
 
1a. Which pocket was your wallet in?
 
1b. Where was your license in the wallet?
 
1c. Where was your registration? console or glove compartment?
other location?
 
1d. How is that compartment opened?
 

1e. Please take several photos of the interior of the vehicle showing the presence or absence of a console. Open the driver's door and take them in a series starting from the front showing the door open and the license plate, then take another as you move around to the side of the car then approach the car so you can see the presence or absence of a console. A total of 5-7 photos is ideal, but are not necessary for the first court date.

Send them to joseph@waldbaumlaw.com.

Take several photographic views of the shoes you wore during your arrest from the bottom, both sides and behind showing conditon of soles and heels and send to joseph@waldbaumlaw.com.
 
2. What were the officer's first words to you when he/she encountered you? (Be exact)
 
3. What did you say in response to this question?
 
4. Were any containers of alcohol visible to the officer as he/she observed from outside your vehicle?
 
5. Was any other suspicious or illegal item or items (i.e., weapon, rolling papers, bong, marijuana pipe or "roaches") visible from outside your car when the police approached your vehicle?
 
6. If so, give details:
 

10. FIELD SOBRIETY TESTS OR ROADSIDE SOBRIETY TESTS
 
1. Did the officer direct you (or "request" you) to perform any coordination or roadside sobriety tests?
 
2. Exactly when (how many minutes, seconds after getting out of car) were you
first requested to (told to) perform these tests?
 
3. What was the exact wording used by the officer in making this "request or demand"?
 
4. Did the officer ask you any preliminary questions about your physical limitations
or impairments or present illnesses/medications before beginning to "test" you?
 
5. Was there anything about this traffic stop that led you to believe that this was
not going to be a "brief" encounter with the police, but that you were going to be
detained for a more prolonged period of time?
 
6. If "yes", give specific facts or reasons for this belief
(e.g., took my license, said "you're not going anywhere after this," etc.):
 
7. Describe shoes (if wearing any) during field sobriety tests:
 
8. What were the agility or coordination tests that you performed in the order given,
and how did you do?
 
9. Road or shoulder conditions where tests were given
(select all that apply):
: Level
: Sloping
: Smooth
: Rocky
: Wet
: Grassy
: Dirt
: Holes
: Ruts
: Wide
: Narrow
: Calm
: Line to Walk On
: No Line to Walk On
: Raining
: Snowing
: Hot
: Cold
10. Glasses:

11. Contact Lenses:

12. Emotions:
: Crying
: Nervous
: Can't Recall
13. Traffic:

14. Emergency lights still flashing while tests being conducted?
 
15. Were you shaking when you were being given the tests?
 
16. Did the officer demonstrate any or all of the tests before you did them?
 
17. Did the officer advise you what you had to do on each test to pass it?
 
18. Did the officer ever indicate to you that these agility tests were optional?
 
19. Did the officer ever make any statement or promise to you that if you passed
these tests, that he/she would let you go home?
 
20. Did the officer ever indicate (in any manner or fashion) that by not taking field
sobriety tests, that you would be subjected to immediate arrest?
 
21. Did you ever blow into a hand-held alcohol tester at the scene of the stop?
 
22. If so, were you permitted to SEE the digital reading that the tester indicated?
 
23. If so, what was the reading?
 
24. If not permitted to see it, did the officer tell you the result?
 

11. ARREST
 
1. Were you ever told you were "under arrest" or similar wording to indicate that you were going to jail?
If so, please indicate when and by whom.
 
2. Were you told exactly what you were being arrested for?
 
3. If the officer told you one offense (e.g., "OUI"), did he/she also advise you about
being charged with the other traffic offenses for which you were ticketed?
 

12. CONVERSATION AFTER ARREST
 
1. What did the officer say or ask first after you were arrested?
 
2. Were you struck, pushed, injured, verbally abused or "roughed up" by the officer(s) when you were arrested?
If so, describe:
 
 
13. VEHICLE TOWING OR REMOVAL FROM SCENE [Complete Applicable Parts of This Section]
 
1. Were you present when it was taken (towed) from scene?
 

14. SEARCH OF VEHICLE
 
1. Was your car searched?
 
2. Were you present?
 

15. AT STATION/JAIL/TESTING FACILITY
 
1. If you saw a clock when you arrived, please indicate what time it was:
 
2. How many officers were there?
 
3. Were you asked any health or environmental contamination questions, such as
"are you taking medication", "do you have false teeth or a bridge", "have you been
around any paint vapors or other chemicals today", etc., before you took the State's test?
If so, what were you asked, and what was your response to these questions?
 
4. Were you videotaped?
 
5. If you signed any papers, what were they?
 
6. Did the arresting officer (or any officer) ask you about prior OUI offenses or comment to you that your computer record showed prior OUI(s)?
 
7. Without being asked about this, did you say anything to the officer about
prior OUI's that you had? If "yes", give details:
 
8. Was the arresting officer physically present in the room where you were given the test, and did he/she keep you in view the entire time that you were at the testing facility? Please explain:
 
9. Did he/she or any other officer(s) in the testing room have their walkie-talkie
or portable radios on their belt or shoulder when they were in the testing room?
 
10. While in the room where the testing was being conducted, did you ever
hear or observe an officer (any officer) use radio equipment in communicating
with the dispatcher or with other officers? If yes, please give details:
 
11. Was anyone smoking in the testing room prior to or during the time you were being tested?
 
12. Were you permitted to go to the restroom? If so, when?
 
13. Were you permitted to make a telephone call? If "Yes" when was this permitted, and who did you call?
 
14. Were you allowed to smoke, drink water or put anything into your mouth within
15 minutes before the test was administered? If so, give details:
 

16. BREATH TESTS
[The next two sections should be completed by you ONLY if you were administered a breath test at a police precinct/jail or a mobile testing van by the police AFTER your arrest.]
 
1. Testing officer's/operator's name:
 
2. Officer's/Operator's police agency:
 
3. Officer/Operator present when you arrived?
 
4. Did officer/operator arrive afterwards? When?
 
5. Did the operator turn on the breath machine and wait over 15 minutes before asking you to "blow"?
 
6. When did the testing officer/operator begin "observing" you prior to the testing?
 
7. Was this observation continuous and uninterrupted?
 
8. Where was the arresting officer during this time?
 
9. Did anyone ask to look inside your mouth before you were tested?
 
10. At the breath testing location, did anyone ask you if you had been around paint vapors, volatile chemicals or solvents during the day prior to when you were stopped?
 
11. Did anyone ask you about false teeth, "bridge" work or dental plates?
 
12. Did you have a "fever" or elevated body temperature when tested?
If so, was the elevated body temperature from: Dancing? Exercising? Sunbathing?
Something else? Indicate other cause:
 
13. Are you a smoker?
 
14. Did you have any difficulty performing the breath test? If so, give details.
 
15. If a repeat "blow" was required on the official chemical sobriety test (not the hand-held test), was the mouthpiece changed each time?
 
16. In the 12 hours immediately prior to being tested on a breath machine, were you exposed to (i.e., breath or work with) solvents, cleaning solutions, paints, active, mineral spirits or any similar caustic or aromatic products?

If so, please describe:
 

17. CONVERSATION WITH BREATH TESTING OPERATOR
 
1. Did the breath-testing operator ask you any questions? If so, what did s/he ask?
 
2. Did the breath test operator give you any instructions or explain how the
machine worked or how you were to "blow" into the machine? If so, what were the instructions?
 
3. When you gave the breath sample, was your body in an upright position
(perpendicular to the floor), or were you leaning forward to reach the mouthpiece
from a sitting or standing position? Describe in detail:
 

18. BLOOD TESTS
[THIS SECTION SHOULD ONLY BE COMPLETED IF YOU ARE AWARE A BLOOD TEST WAS TAKEN.]
 
1. What is the name and location of the hospital where you went and a blood test was performed?
 
2. When did this occur, in relation to your time of arrest?
 
3. Did you consent to having this blood sample taken from you?
 
4. What were you told or asked by the police in order to obtain your consent
for this sample to be taken from you?
 
5. Who drew (took) your blood sample?
 
6. Were you required to sign any forms before the nurse/doctor/technician
would take your blood? If so, what did you sign?
 
7. Did the person who took your blood sample use any type of cloth or swab
to cleanse the surface of your skin before taking the sample?
If so, please describe what was done to prepare the skin:
 
8. As the needle was removed from your arm, did the person who took the sample
hold a swab or cloth over the puncture site?
 
9. What happened to the blood sample after it was collected from you?
(Be as specific as possible)
 
10. Were you told (or were you under the impression) that if the police took a blood test
that you could not request your own independent test of your blood or breath, by a different medical or laboratory provider?
 

19. RIGHT TO COUNSEL
 
1. Were you ever advised by anyone that you had the right to consult with an attorney?
If "Yes", by whom and when?
 
2. Did you ever ask to call an attorney? Did you know a number?
 
3. Did you have the opportunity to make the phone call? If so, when?
 
4. If you were denied the right to call an attorney before deciding whether to take the
State's test, did the officer (or anyone at the station) explain why you were being denied
access to legal counsel? If so, what was the reason?
 
5. Were you given a phone book?
 
6. Were you physically able to read that night (i.e., coherent and not impeded or restrained)?
 
7. When were you told you could make a phone call to anyone else, if you desired?
 
8. Did the police cooperate with you in providing phone access?
 
9. Could you talk privately?
 
10. Were the police listening in on your conversation?
 

20. FORMS SIGNED
 
1. Did you ever sign your name?
 
2. What documents did you sign and why?
 
3. Did you ever refuse to sign your name on any document(s)?
If so, why and what document(s)?
 

21. VIDEO OR AUDIO TAPING
 
1. Any clue(s) (i.e., officer mentioned it) that a tape may have been being made? Explain:
 

22. RELEASE FROM JAIL
 
1. What was the date and time of your release?
 
2. Were you released to someone? If so, please include their name, address, and phone number.
 
3. How did that person know to come to assist you?
 
4. Any conversation with him/her? What did you talk about?
 
5. Was there any discussion about getting an independent test? If so, give details:
 
6. How much money did you or another person have to post in order to be released:
 

23. ACCIDENT
[This section is to be completed ONLY IF an accident of some type has occurred in connection with your DUI arrest.]
 
1. Were you involved in an accident?
 
2. One car or more than one car involved?
 
3. Describe accident:
 
4. After the accident, did you ever leave the immediate area (for any purposes, such as to call a tow truck, call police, etc.)?
If so, give details of how long you were gone, where you went, why you left, etc.:
 
5. Were there any injuries to any other person(s)? If so, give full details:
 
6. Did an airbag deploy inside your vehicle? If so, give details of how it affected you:
 
7. Did the officer ever ask you about what you had had to drink and when it had been consumed?
 
8. Were you given any Miranda advisements before the officer(s) began to question you?
 
9. Prior to this case, had you EVER been the driver of a vehicle in which another person
[passenger, person(s) in other car, pedestrian(s)] were injured or killed? If so, give details:
 

24. DRIVING AND CRIMINAL RECORD
[NOTE: The prosecutor will have this information, and I must know the entire history to be able to properly analyze your chances at trial.]
 
1. Have you ever been arrested anywhere for anything?
If so, where, what were the charges and how was the case disposed of?
 
2. Have you had a prior DUI in your LIFETIME ANYWHERE?
 
3. If so, give details below. Include as much of the following as you can:
the city and state, case or citation number, the court the case was handled in,
the attorney the case was handled by, whether it was a plea or went to trial, and the result.
 
4. List any other DUI convictions (including nolo contendere pleas) during your lifetime anywhere.
Be as specific as possible.
 
5. Ever required to take "alcohol classes?"
 
6. Are you on probation for any other offense(s)? If so, give details:
 
7. Prior criminal record of any type (not already mentioned), especially alcohol-related or
drug-related charges, such as "underage possession of alcohol", "open container violation", possession of marijuana, public intoxication:
 
8. Have you ever been sentenced to time in jail?
 
9. If so, for how long?
 
10. Provide details:
 

25. REFUSAL OF THE STATE'S BREATH or BLOOD TESTS
[Complete this section ONLY IF you REFUSED (or allegedly refused) to submit to the State's breath, or blood tests as requested by the arresting officer.]
 
1. What actions were taken or statements were made by the police officer
to you just prior to your alleged refusal to take the state's test(s)?
 
2. Why did you refuse (or why did the officer claim that you refused) the State's test(s):
 
3. Were you aware that your license (or privilege to drive on Massachusetts highways)
would be suspended for refusing to submit to the State's test(s)?
 
AUTOBIOGRAPHY
What was going on in your life before this incident?
Divorce? Job loss? Family issues?
 

We want to get to know our clients as people.
Please provide as long or short an autobiography as you wish.

 
   
 
To avoid duplicate entries,
please submit the questionnaire only once. 		 

ALL INFORMATION IS ENCRYPTED IN TRANSMISSION
AND PROTECTED BY THE ATTORNEY-CLIENT PRIVILEGE

Joseph Waldbaum, Esq. 978 921 4100 Fax 978 349 6800

  

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