Oldham County Health Department
1786 Commerce Parkway
La Grange, Kentucky 40031                                                                                                                      502-222-3516 ext 137
oldhamcountyhealthdepartment.org                                                                                                                                                                  

Congratulations on taking this important step to understanding and supporting your child's development. This is a fun and interactive way for you to spend special time with your child while learning where he/she is in the developmental process.

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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)

I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online screening program. I will fill out the questionnaire about my child's development and promptly submit the completed questionnaire through this Family Access online questionnaire completion system. 

Your Participation in the Ages & Stages Questionnaires® (ASQ) Means: 

Ages & Stages Questionnaires® (ASQ) screenings will be completed on your child’s overall developmental skills. These screens will identify your child’s strengths as well as any areas where your child may need practice or support. 

Giving Permission Means: 

  • You freely agree to participate in the ASQ screenings. 

  • You can change your mind about participating in the ASQ screenings at any time. 

  • Oldham County Health Department, an affiliate of Help Me Grow Kentucky, will contact you for future screenings.  You can opt out of these future screenings at any time. 

  • You agree to Oldham County Health Department sharing information with your health care provider, Help Me Grow Kentucky, First Steps, and/or local school districts for referrals to services that may help your child. 

  • Your child’s ASQ results cannot be released to other persons, or programs without your permission. 

  • You always have access to all information collected by Oldham County Health Department about your child. 

  • You agree to ongoing communication and screenings through Oldham County Health Department.

 

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.