DUI Court Evaluation Preparation Checklist Form
Use this form to organize the information, documents, and logistics needed before a DUI court evaluation.
Court Evaluation Details
Scheduled Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Scheduled Evaluation Time
*
Hour Minutes
AM
PM
AM/PM Option
Location / Office Name
*
Preferred Contact Method for Reminders
Please Select
Phone
Email
Text Message
Other
Supporting Information
Do you have any prior DUI-related paperwork?
*
Yes
No
Not sure
Are you currently in treatment or counseling?
*
Yes
No
Prefer not to say
What support do you need for the evaluation?
Interpreter support
Mobility/accessibility support
Hearing support
Vision support
Other
Self-Assessment of Preparedness
How prepared do you feel for the evaluation?
*
Not prepared
1
2
3
4
5
6
7
8
9
Fully prepared
10
1 is Not prepared, 10 is Fully prepared
Notes on unresolved items, missing documents, or follow-up reminders
Submit
Should be Empty: