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What county and court
is your case in?
Next Scheduled Court Date:
What are you charged with?
What was the date and
time of your arrest?
Are you on probation or parole?
Have you ever been arrested or charged before?
If you were stopped for DUI please continue on to the form below.
Otherwise click Submit now to send your information to LACD.
Did you take a chemical test? If so please check all tests you did.
I took no tests.
Breath Test at the Location I was pulled over.
Breath Test at the jail or police station.
What were the results of the test?
Breath Test At Car:
Breath Test At Station/Jail:
Were you given a temporary license (pink sheet)?
* Your license will automatically be suspended 10 days from the date on the temporary license
unless we request a hearing within those 10 days.
Call us now at (310) 460-3541 to schedule an appointment.
Have you requested a
hearing at the DMV?
Do you have any medical conditions or do you rely on daily medication?
Are you diabetic?
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