Client Information and Intake Form

Fill out the intake form below or download the intake form document and fill it out manually.



Check all that apply: *











(required)

Have you Received any Tickets in the Last 2 Years? *
Have you have ever been Previously Charged or Sentenced for DUI, Leaving the Scene of an Accident or DWLS? *

*** Only Complete if Cited for Criminal Violations ***

Are you currently on (check all that apply):




Are you out on a Cash Bond?
Are you out on a Surety Bond?

* required fields