Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ-3™ English

List others assisting with completion of the questionnaire

I have read the information provided about the Ages & Stages Questionnaires: SocialEmotional, Second Edition (ASQ:SE-2), and I wish to have my child participate in the online screening. I will fill out the online questionnaire about my child’s social-emotional development and will promptly submit the completed questionnaire through Family Access.

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