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Client Intake Drivers License Evaluation: Law Office Of Lee Meadows
Some of this information is quite personal, however we need it to adequately evaluate your driving history and arrive at the best solution tailored to you. Be assured you are entering a place where you won't be judged for your past, but equipped for your future. Omitting information will interfere with our ability to adequately assess your case. This information is confidential.
ATTENTION: IN ADDITION TO THIS FORM, PLEASE SEND ANY AND ALL PAPERWORK YOU HAVE ABOUT YOUR ISSUE TO meadowslegalteam@gmail.com
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Email
*
Your email
If you'd like for us to be able to discuss your case with someone else, please list names below. If you don't wish to speak to anyone else, please indicate N/a
Your answer
Name
*
Your answer
Phone Number
*
Your answer
Address
*
Your answer
Email
*
Your answer
D.O.B.
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MM
/
DD
/
YYYY
Are you currently driving under special supervision? If so, what are the conditions? Who is administering your supervision. If not, please indicate n/a.
Your answer
Do you have any arrests whether they were related to driving or not? Please provide dates and circumstances. If none, please indicate N/A.
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Your answer
Have you had any criminal convictions, whether related to driving or not? If so, please provide dates, the lawyer who represented you, case numbers, and what penalties were imposed. If none, please indicate N/A.
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Your answer
Were you ever incarcerated and if so, for what offense or offenses? Please provide the date of your offense or offenses. If incarcerated, when did incarceration commence, where were you last incarcerated, when you were released and what was your DOC number? If none, please indicate N/A.
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Your answer
Do you have a Commercial Drivers License (CDL)
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Yes
No
If you have a CDL , please provide the number.
Your answer
Are you sober? If so, please indicate your number of years sober.
Your answer
Do you currently attend a Twelve-Step Recovery Program? If so, how long have you attended and how many times per month?
Your answer
Weight
*
Your answer
Eye Color
*
Your answer
Provide your
FLORIDA DRIVERS LICENSE number and the year you have had it. If you cannot remember the number, please indicate that as well.
*
Your answer
If you have a
Florida state-issued ID
instead of a driver license,
please provide the ID number.
If you don't have a Florida state issued ID, please answer N/A.
*
Your answer
Are any of the following true? Check all the apply.
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I might owe back child support
There may be outstanding judgments against me
I may owe court costs.
I have drug convictions
I have a medical condition that a doctor thinks could impact my driving.
I am on probation.
Not applicable to me.
Required
Social Security Number
*
Your answer
Sex
*
Male
Female
Height
*
Your answer
What goals do you have regarding your drivers license.
Be able to legally drive again
To understand why I cannot obtain a drivers license.
My job opportunities are limited because I cannot legally drive
Other.
What State(s) do you wish to drive in?
Your answer
What is your budget to further address your driver license issues? We have affordable options.
*
Less than $500.
$500-$1000
$1000-$2000
$2000-$5000
I will pay whatever it takes
My employer is paying for my legal services.
Is there any additional information you believe we should know before we start your case?
Your answer
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