Traffic and/or Criminal Intake Form

Bold labels and This graphic indicates a required field. indicate required information.

Secondary Contact (someone we can contact if we cannot reach you):

Charge(s) Details:

(Note: Information is Required For Preparation of Limited Driving Privilege)

Have you had a Drug & Alcohol Assessment:

Was Your License Taken:

Do You Have Your License Back:

Was Breathalyzer Refused:

Was Your Blood Drawn:

For Expunctions, ONLY:

(Note: Information is Required For Preparation of Expunction Application)

For Violations of Domestic Violence Protective Orders, ONLY:

Does the Other Party Have an Attorney:


The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

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