The McGee Law Firm. 213 Princess Street Wilmington, NC (910)

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1 The McGee Law Firm 213 Princess Street Wilmington, NC (910) DWI CLIENT INTERVIEW Date of Interview: Name: Address: Phone numbers: Home: Work: Cell: address DOB: / / Offense Date: DL#: SSN: Sex: Race: Height: DL state: Weight: Eye color: Hair color: EMPLOYMENT Employer: Job Title: Address: Phone Number: Duties: Length of Employment: Vehicle used in Employment? Job Dependent on License? If Yes, what kind:

2 PRIOR RECORD Prior DWI s: How many: What state: Lawyers Name: Outcome: Prior Speeding Tickets: How many: What state: Lawyers Name: Outcome: Presently on Probation: If yes, explain: EDUCATION High School Graduate? name/city: College Graduate? / current name/city: Special Training: FAMILY (please circle) Married Single Divorced Widowed Engaged Spouses name: Employment: Children? Ages: MILITARY Branch: Rank: Honors, Recommendations Date of Discharge: Type of Discharge: Where Served: HEALTH Eyes Do you wear glasses? Do you wear contacts? Do you have vision in both eyes? Any other eye problems; for example, conjunctivitis, eye muscle fatigue, glaucoma, etc. Please explain: Ears Do you wear hearing aids? Do you suffer from vertigo? Inner ear infections? Diagnosed hearing defects? Injury to ears? If yes, please explain: Additional information about ears/hearing conditions:

3 Lungs & Respiratory System Do you have Asthma? Do you smoke? If yes, how much per day? Do you have any type of cancer? If yes, please specify: Endocrine System Are you diabetic? Type I or II: Do you take insulin? If yes, what dose? A.M. P.M. Circulatory System Do you have heart disease? Do you have circulatory problems? Do you take blood thinners? If yes, please list: Skeletal System Have you suffered injuries to, or have deformities in your: Feet? If yes, describe: Ankles? If yes, describe: Knees? If yes, describe: Legs? If yes, describe: Back? If yes, describe: Spine? If yes, describe: Hands? If yes, describe: Fingers? If yes, describe: Neck? If yes, describe: Do you suffer from arthritis? If yes, where? Neurological/ Psychological/ Psychiatric Have you ever suffered a stroke? If yes, when? Do you have any partial paralysis? If yes, where? Have you suffered injury to the brain? If yes, when? Have you ever seen a psychologist of psychiatrist? If yes, when? What was the diagnosis? Were you placed on medication? If yes, please list: Have you been diagnosed with: ADD / ADHD If yes, when: Were you placed on medication? If yes, please list: What are the side effects of these medications? List all other medical conditions:

4 Do you suffer from: headaches migraines If so, how often: depression? anxiety attacks? nervousness? If yes, are you on medication? If yes, please list: Oral / Dental Do you have...(please circle all that apply) periodontal disease extensive bridge work loose caps/crowns dentures If yes, please explain and list medications, if any: GENERAL INFORMATION Do you have any balance or coordination problems? If yes, please explain: Do you have any condition which would affect your ability to perform field sobriety tests? If yes, please explain: Do you have any condition which might make you appear to be intoxicated? If yes, please explain: EVENTS ON DAY OF ARREST Date of arrest: Time: Day of week: List all prescribed and over the counter medications you took on the date of offense: Hours of sleep the night before: Normal hours of sleep: Food intake Breakfast: Lunch: Dinner:

5 Beverage consumption Breakfast: Lunch: Dinner: Alcohol consumption: Where were you when you started drinking? What time did you arrive? What time did you leave? What time did you begin drinking? What time did you stop drinking? Number of drinks at this location: Type of Drinks If mixed drinks, who prepared the drinks?: Witnesses to corroborate drinking at this location?: List all food eaten while there Next location: Where were you when you started drinking? What time did you arrive? What time did you leave? What time did you begin drinking? What time did you stop drinking? Number of drinks at this location: Type of Drinks If mixed drinks, who prepared the drinks?: Witnesses to corroborate drinking at this location?: List all food eaten while there Next location: Where were you when you started drinking? What time did you arrive? What time did you leave? What time did you begin drinking? What time did you stop drinking? Number of drinks at this location: Type of Drinks If mixed drinks, who prepared the drinks?:

6 Witnesses to corroborate drinking at this location?: List all food eaten while there Did you have the flu? Did you have a cold? Had you been using paint, paint thinner, or chemicals of any kind? If yes, please specify and explain: Did you have any muscle: (circle all that apply) strains sprains tears atrophy cramps If yes, where? VEHICLE CONDITION Make Model Year Was the vehicle you were driving in good mechanical condition? If no, please explain why: List names and phone numbers of other persons in vehicle: EVENTS PRIOR TO CHARGE Please describe the route you were driving prior to the arrest. State where you were coming from and where your final destination would have been, indicating stops on the way.

7 Where were your keys?: Was the car door locked? Y/ N Difficulty putting key in lock? Y/N Where parked? Parking break on? Y/ N Difficulty putting key in ignition? Y/ N Take two hands to engage ignition? Y/ N Lights: On/ Off? Drive in reverse before you went forward? Y/ N Which way did you turn? Right/ Left POLICE ENCOUNTER Describe weather conditions Location of stop and arrest When did you first notice the police officer? What lane were you traveling in? What speed were you traveling? Immediately after noticing blue police lights, what was the first thing you did? What do you think attracted the officer s attention? How long did it take to stop your car? Where did you stop? Where was the police car in relation to your car? Describe the first thing you did after stopping Did you turn off the ignition? Did you turn off your lights? Did you have any difficulty with the above items? What reason was given by the officer for stopping you? Did you have your license and registration ready before the officer asked? Did you have to fumble through things to locate your license and registration? Were you sprayed with pepper spray or mace at the time of the incident? What was the first thing the officer said to you and how did you respond?

8 What questions did the officer ask you prior to getting you to step out of the vehicle? FIELD SOBRIETY TESTS Did the officer get you to take any field sobriety tests? If so, list all the tests you took and how well you performed: Were there any distractions while taking the tests? If yes, please describe: Describe the conditions where you took the field sobriety tests: (circle all that apply) level sloping rocky smooth wet dry grassy dirt pavement wide narrow holes ruts Were there people gathered? If yes, how many? How did you feel during the tests? Did the officer demonstrate each test before you did it? Did the officer tell you what you had to do to pass each test? Did the officer tell you whether or not you passed each test? THE ARREST Did the officer give you a breath test before your arrest? If so, how many times? Did the officer tell you that you were under arrest? How long between the tests? If so, when? Did the officer tell you why you were under arrest? If so, what was the reason? Were you handcuffed? Were you given a Miranda warning? Was it read to you?

9 Did you understand the Miranda warning? Did you say anything before the Miranda warning was read to you? If so, please describe: Did you say anything after the Miranda warning was read to you? If so, please describe: Were there any witnesses to the arrest? If so, please list: AFTER THE ARREST Did the police administer: (please circle) blood test breath test Who administered the test? Was anyone else present during the test? If yes, who? Were you told you had a right to have a witness present during the test? Were you told you had the right to contact an attorney? If you contacted an attorney, when did they arrive? Did the attorney witness the testing procedure? Were you given access to a telephone and a telephone book? Did the person administering the test run a simulator test first? How many breath tests did you take? Were any breath samples saved? Did you burp, belch, or regurgitate during any of the breach tests? Was the testing process video taped? Were any field sobriety tests performed at the jail? If so, please describe each test and how well you performed: Did you sign any forms or documents? If so, please list: Did the officer talk to the magistrate about probable cause? If so, what was the probable cause the officer gave to the magistrate?

10 Did the magistrate inform you in writing the established procedure to have others be present at the jail to observe our condition? CONDITIONS OF RELEASE Time of release: Total amount of time in custody: Did you make bond? If you were unable to make bond, did the magistrate inform you, in writing, the established procedure for administering an additional chemical analysis? Did the magistrate write down the names and contact numbers whom you wished to contact to make bail? Name of bonding company surety: What conditions of release were imposed by the magistrate? ACCIDENT INFORMATION (to be completed only if an accident occurred) Were you injured in any way? Were you wearing your seat belt? Did you hit your head? Did your air bag deploy? Were you taken to the hospital? If yes, which one: Were you ever unconscious? Do you remember speaking with a police officer? CLOTHING DESCRIPTION: Please describe the clothing you were wearing at the time of arrest: ADDITIONAL INFORMATION If there is any other personal information that you feel will help with your defense, please explain: The McGee Law Firm thanks you for filling out this form, it will be helpful in developing your case.

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