Palos Verdes Medical Group
310-544-6858
info@PVMedGroup.com
550 Deep Valley Drive, Suite 319
Rolling Hills Estates, CA 90274
www.PVMedGroup.com

Welcome to Palos Verdes Medical Group's Ages & Stages Questionnaires, Third Edition (ASQ-3). Please take a few moments to fill out the questionnaire. Feel free to contact us if you have any questions.

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Because your child's first 5 years of life are so important, we want to help you provide the best start for your child. You've been invited to participate in the Ages & Stages Questionnaires, Third Edition (ASQ-3), to help you keep track of your child's development. The questionnaire may be provided every 2-, 4- or 6-month period. You will be asked to answer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills.

Please enter your child's birth date and the number of weeks he or she was born premature below to start the screening. Please note that the information you enter into this website is secure and cannot be seen or accessed by anyone other than the program employees who have invited you to participate in this screening.

We look forward to your participation in ASQ-3!



(put "0" if not premature)

Confidentiality Notice: This content is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited and may be unlawful. If you are not the intended recipient, please contact Palos Verdes Medical Group.

Note: By clicking "Submit", you are agreeing to both our Family Access End User License Agreement and any other consent or authorization information outlined on this page.