Alcohol Calculation Questionnaire Return to: Keith Borer Consultants Fax: 0191 332 4990 Locard House Email: Belmont Business Park Durham DH1 1TW Solicitors’ Firm: PERSONAL DETAILS Name: Age when tested: Sex: Male Female Height: Time of driving/incident: Weight: Breath Blood Evidential Test Result: of test/sampling: Time Please enclose test printout or certificate of analysis INSTRUCTIONS Please calculate the effect of: Spiked drinks Post driving drinking Medications Please calculate my likely alcohol level: When I drove At the following time: Alcohol consumed BEFORE driving/incident: Date Time Amount Type (e.g. measures, can/bottle size) (give name if known) Alcohol consumed AFTER driving/incident: Date Time Amount Type (e.g. pints, measures, can/bottle size) (give name if known) Comments (e.g. which of the above drinks were consumed unwittingly) Please note: changes to information provided will incur additional costs
Alcohol Calculation Questionnaire Return to: Keith Borer Consultants Fax: 0191 332 4990 Locard House Email: Belmont Business Park Durham DH1 1TW Solicitors’ Firm: PERSONAL DETAILS Name: Age when tested: Sex: Male Female Height: Time of driving/incident: Weight: Evidential Test Result: Breath Blood Time of test/sampling: Please enclose test printout or certificate of analysis INSTRUCTIONS Please calculate the effect of: Spiked drinks Post driving drinking Medications Please calculate my likely alcohol level: When I drove At the following time: Alcohol consumed BEFORE driving/incident: Date Time Amount (e.g. measures, can/bottle size) Type (give name if known) Alcohol consumed AFTER driving/incident: Date Time Amount (e.g. pints, measures, can/bottle size) Type (give name if known) Comments (e.g. which of the above drinks were consumed unwittingly) Please note: changes to information provided will incur additional costs
Alcohol%20Questionnaire%20Sept%2017.docx