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Offices by Appointment

8370 Veterans Highway
Suite 201
Millersville, MD 21108

Mailing Address

Post Office Box 694
Columbia, MD 21045

Telephone

443-324-5289

Facsimile

410-729-4186

DUI Defense

DUI Arrest Evaluation

If you have been arrested for or charged with Driving Under the Influence or Driving While Intoxicated, complete this FREE DUI Arrest Evaluation Form, or call 443-324-5289 to set up a FREE Initial Consultation with Scott Athen.

If you have received a Maryland traffic citation, but have not been arrested for DUI/DWI, please complete the Traffic Citation Evaluation. If you have been arrested for a non-traffic related incident, please complete the Criminal Arrest Evaluation.

Completion of this survey does not create an Attorney-Client Relationship between the person completing the form and The Law Offices of Scott C. Athen or Scott C. Athen, Esq.  However, the information provided by completing this form is protected under Attorney-Client privilege, and will not be released to anyone other than Scott Athen.  Upon receiving and reading your answers, Scott Athen will contact you (yes, you read that correctly, Mr. Athen will call you himself) within one business day by the means chosen at the beginning of the survey to arrange your FREE Initial Consultation at his office, or in your home.  Evening and weekend appointments are available.

Fields marked '*' are required.

How did you find AthenLaw.com? (If not listed, please specify)	Choose One Alta Vista Attorney Find Business Card Drunk Driving Defense Sites Excite Google Goto Hotbot Infoseek Legal.net Lycos National Motorists Association Referred by Someone Starting Point Webcrawler West Attorney Listings Yahoo Other
Full Name*
Street Address*
City*
State*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massacheusetts Michigan Minnesota Mississippi Missouri Montana Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
E-mail address*
OK to e-mail you at this address?	Yes No
Phone No.*	Home Work Cell Other
OK to call you at this number?	Yes No
Alternate Phone No.	Work Cell Other
OK to call at this number?	Yes No
Date of Birth*
Height*	Height 4' 0" 4' 1" 4' 2" 4' 3" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0" 7' 1" 7' 2" 7' 3" 7' 4" 7' 5" 7' 6" 7' 7" 7' 8" 7' 9" 7' 10" 7' 11"
Weight*	Pounds
Education	Choose One No High School Some High School High School Grad Some College College Degree (2-Year) College Degree (4-Year) Some Graduate Graduate Degree Some Doctorate Doctorate
Employment*	Choose One Accomidation Accounting Agriculture Amusement & Recreation Banks & Financial Institutions Communications Computers Construction Consulting Education Electronics Financial Brokers & Exchanges Fishing Food & Beverage Government - Federal Government - State Governmebt - Local Health & Social Services Homemaker Insurance Legal Manufacturing Mining Oil & Gas Personal/Individual Real Estate Retail Secretarial Security Services Storage & Warehousing Student Telecommunications Utilities Other
Length of employment*	Mo/Yr Months Years
Drivers license No.*
Drivers license State*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massacheusetts Michigan Minnesota Mississippi Missouri Montana Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Commercial license?	Yes No
Years driving	Years
Miles driven per year
Alcohol type	Type None Beer (12 oz.) Beer (Pint) Mixed Drink Long Island Tea Shot Wine (Glass)
Number of drinks
Time of first drink	(hh:mm AM/PM)
Time of last drink	(hh:mm AM/PM)
Is this your first DUI/DUI anywhere?* If you have prior DUI/DWIs, please provide information.	Yes No (Mo/Yr--State--County--Result)
Date of arrest*	(dd/mm/yy)
Time of stop	(hh:mm AM/PM)
County arrested in*	Choose One Allegany County Anne Arundel County Baltimore City Baltimore County Calvert County Caroline County Carroll County Cecil County Charles County Dorchester County Frederick County Garrett County Harford County Howard County Kent County Montgomery County Prince George's County Queen Anne's County St. Mary's County Somerset County Talbot County Washington County Wicomico County Worcester County
Street or location of arrest*
Name of police department
Officer's name & badge number
Why were you stopped/arrested, according to the Officer?*
Please list all Citation Numbers*
Arrest Code
Please list all charges*	List by Statute Number e.g. 21-902(a)(1)
Was anyone injured?	No one was hurt/Not applicable Myself Passenger(s) in my vehicle Driver/Passenger(s) in another vehicle Pedestrian Not Sure
Were there any witnesses with you who could testify for you?	No Yes
Which were given?* (check all that apply)	Handheld breath test Walk-and-turn One-leg-stand Follow pen with eyes Alphabet Touch your nose Other
Was each test explained and demonstrated by the officer?*	Yes No
How do you think you performed the tests?*
Do you have any medical conditions or injuries that could have affected your eyesight or balance? If 'yes', please provide details.	Yes No Don't Know/Not Sure
Did you take a breath test?*	Yes No
Why did you or did you not take the test?*
!!!IMPORTANT!!! If you took the breath with a result of .08 or more, or refused to take the test, you face an automatic license suspension between 45 days and 1 year. You have only 10 days from the date of your arrest to file a request for a hearing with the office of administrative hearings to contest this sanction and guarantee the hearing will be held before you lose any driving privileges.  The absolute deadline for requesting a hearing is 30 days. CALL SCOTT ATHEN IMMEDIATELY FOR ASSISTANCE!!! 443-324-5289 If you took the breath with a result of .08 or more, or refused to take the test, click here if you have not yet requested a hearing
If you took a breath test, you should have a printout titled 'Subject Test Record'.  List the results here* (You may have 2 or 3 SUBJ readings)	STD . SUBJ . SUBJ . SUBJ . STD .
Time of breath test	(hh:mm AM/PM)
Were you directly observed by an officer for the entire 20 minutes prior to taking the breath test?	Yes No Don't Know
Did you ever ask to speak with a lawyer? If 'yes', when? (please give details)	No Yes
Additional comments

Please click 'Send DUI Arrest Evaluation to Scott Athen' only once.