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)

For ASQ-3™ English

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

Thank you for taking this important step to better understand your child's development.  The Ages and Stages Questionnaire (ASQ-3) is a developmental screening, not a test, and the activities are set up to be accomplished through play with your child! We recommend that you print out the questionnaire and review the activities before you begin because you will need to have a few items on hand such as blocks, a ball, a pencil, etc., depending on your child's age. 

Once the screening is submitted, Sprouts Child Development will contact you by email or phone with your child's results.  If the questionnaire results indicate your child is developing with no concerns, you will receive an email with their screening profile and printable handouts with suggested activities to continue encouraging your child's development. If the questionnaire results show any concerns, a member of the Sprouts Child Development team will contact you for more information to discuss possible next steps.

Please note the information you enter into this website is secure and will not be shared with anyone without your written consent.  If your child attends a childcare or preschool program that is in Partnership with Sprouts Child Development, you have signed a consent form as part of your enrollment process. Your child's results will be shared with the Program Director/Teacher for lesson planning purposes.  

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.