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FREE CONSULTATION

Below, you will find a detailed contact questionnaire.  Please complete this form to the best of your ability and we will give you a call within 24 hours to either arrange or complete a consultation.

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Name *

First

Last

Phone *

Email

Where do you currently live? *

City and State

My case is located in the following county: *

• Cumberland
• Sagadahoc
• Lincoln
• Knox
• Waldo
• Hancock
• Washington
• Other

I am seeking help with a Protection From Harassment or Protection from Abuse matter: *

• Yes
• No

Next Court Date *

If charged with a crime, I am charged with...Domestic ViolenceDrug PossessionOUIDriving after suspension/habitual offenderCivil Ticket (speeding, lobster traps, burning without a permit, etcAssaultOther (please specify below)

Other (please specify)

Date I Was Charged:

If you were arrested for OUI, did you submit to field sobriety testing?

• Yes
• No

If you were arrested for OUI, did you submit to a chemical test:

• Yes
• No

Which chemical test was performed:

• Breath
• Blood
• Urine

I have been convicted of a crime within the past (check all that apply): *

• 5 years
• 10 years
• 10+ years
• I have never been convicted of a crime

My biggest concerns are (check all that apply):

• Having a criminal conviction on my record
• Employment issues
• Jail time
• My driver's license
• My gun rights (DV cases)
• Fines
• Losing my kids
• Losing my housing
• Other (please specify below)

Other concern (please specify)

Issues I am currently struggling with (check all that apply):

• Mental Health
• Obtaining a mailing address
• Housing
• Obtaining a phone
• Substance Abuse
• Employment
• Other (please specify below)

Other (please specify)

The best times to call are: *

• 8am - 10am
• 10am - 12pm
• 12pm - 2pm
• 2pm - 4pm
• 4pm - 6pm
• 6pm - 8pm
• Anytime

I intend to pay by: *

• Credit Card
• Cash
• Check
• I will need a payment plan

Submit