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Law Offices of Peter F. Goldscheider
438 Cambridge Avenue,Suite 205
Palo Alto, CA 94306
Phone: 650-323-8296

Do you have any previous drunk driving convictions?

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No

If yes how many?

Were you involved in an accident?

Yes
No

If yes was anyone hurt?

Yes
No

Were any of the following field sobriety tests performed (check all that apply)?

Breathalizer
Alphabet
Counting
Balance
Nose

Were you arrested at the scene?

Yes
No

eg. xxx-xxx-xxxx

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