Case Evaluation Form  
 
 

Use of this form is not intended to be a substitute for getting a lawyer,
but it will provide you with important information.

When you submit this form,
Attorney Mishlove will promptly call you back to discuss the case.

For emergency service,
call TOLL-FREE (877)DUI-DREW,  24 hours, 7 days, 
and ask to have Attorney Mishlove paged.

  • Name

   

  • Phone number

  • Alternate phone number

  • Email address
  • Court date written
     on the Ticket:
     mm/dd/yy:
  • Your next court date:
    mm/dd/yy:
  • Date you were stopped:
    mm/dd/yy:
  • In what City and State or Province is your case?

  • In what Wisconsin
    county is your case?

  

  • Describe any reason given by the officer for stopping you.
  • Describe what really happened.

  • Was there an accident?

 yes     no  

  • If so, was anyone hurt?

 yes     no  

  • Which 'field sobriety tests' did you perform?
    Check the ones that apply.
walk & turn
walk heel to toe
stand on one leg
finger-to-nose
horizontal gaze nystagmus - watching pen or light moved laterally
vertical nystagmus - watching pen or light moved up and down
alphabet - full
alphabet - partial
finger dexterity - touching thumb to finger tips
counting

  • Did you submit to a breath or blood test?
    Check all that apply.

breath test at the scene

breath test at police station

blood test at hospital

blood test at police station

I refused a breath test at the scene

I refused a breath test at the police station

I refused a blood test

I was forced to submit to a blood test

  • Test results were (if not yet known,  please so indicate) 

   

  • Did you ask for any type of test yourself?

 yes     no  

  • If so, what type of test?

  • Have you been convicted of drunk driving or refusal in the past?  if so, how many times? 

yes     no  

  • In your past cases, did you have an attorney? 

yes     no    
does not apply

  • Do you have a Wisconsin driver's license?

 yes     no

  • If you do not have a Wisconsin license, what state is your license from?

  • Do you have a CDL?

 yes     no

  • Do you want to fight the case?

 yes     no

  • Are there any other facts that you believe are important?  Please keep in mind that this should NOT include any confidential information, which should be only be discussed personally with your lawyer.