About
Our Firm
Paul Scott
Kelly Thompson
Jeff Zilinski
Douglas I. Buck II
Jessica Sharpe
Kraig Sippell
Kara D. Moore
Rachel Smith
Practice Areas
Personal Injury / Auto Accident
Criminal Defense
Family Law
DUI/OWI
Client Forms
Custody Intake
Criminal Defense Intake
Divorce Without Children Intake
Divorce With Children Intake
DUI/OWI Intake
Guardian Ad Litem Questionnaire
Blog
Media
Results
(810) 265-7161
Contact
DUI/OWI Intake
Client Information
First Name
Middle Name
Last Name
Date
Email Address
Phone
How Did You Hear About Us
Website
Google
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Referral
Marital Status
Select one...
Single
Legally Separated
Divorced
Date of Birth
Number of Children
Current Employment
Level of Education (Circle One)
Select one...
HS
BA/BS
Masters
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Address
City
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Armed Forces Africa/Canada/Europe/Middle East
Armed Forces America (Except Canada)
Armed Forces Pacific
Incident Information
Police Department or Agency that arrested you
Describe Current Charges
Was there a Breathalyzer Test or Blood test requested of you?
Yes
No
Did you comply with this request?
Yes
No
BAC (Blood Alcohol Content)
Please list any prior alcohol related offenses
For this incident, why did you initially become in contact with the police?
Did this incident result in an accident?
Yes
No
If Yes, please explain
Who arrested you? (County Sheriff, State Police, Local Agency)
How long were you in jail for this offense?
You have been charged with?
OWI
OWI High BAC
Other
Do you have any upcoming court dates?
Yes
No
If yes, which court?
Court Date
Goals you have for Attorney Scott to accomplish for you?
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