Brookes ASQ

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Willard School
1250 Ashland Avenue
River Forest, Illinois 60305
708-771-8282

Welcome to the online screening for Ages & Stages Questionnaires, Third Edition (ASQ-3). This questionnaire asks questions about your child's behaviors and social-emotional growth. The information you supply will help reveal your child's strengths, uncover any areas of concern, and determine if there are community resources or services that may be useful for your child or your family. If completing this questionnaire brings up any questions or concerns, we can talk about information and resources that can help.

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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!

Child Date of Birth
Format: YYYY-MM-DD
Child DOB you entered is in the future, are you sure of that? (Please correct the date before proceeding to the next step). Please enter your child's DOB and not the screening date or today's date (Please correct the date before proceeding to the next step). Child DOB you entered is not valid, please format the date like this: YYYY-MM-DD

Weeks Premature
(put "0" if not premature)

Screening Date I am screening my child today (2019-01-23) I screened my child and am entering in the responses to a previous screening

I have read the information provided about the Ages & Stages Questionnaires, Third Edition (ASQ-3), 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.

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.

ASQ :: Ages & Stages Questionnaires