Brookes ASQ

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Help Me Grow Yuba County
(800) 794-4067
HMGYubaCounty@co.yuba.ca.us
5730 Packard Ave. Suite 100
Marysville, California 95901
http://www.helpmegrowyubacounty.com/parents.html

Welcome to the Help Me Grow Yuba County developmental screening program page! Please contact us at (800) 794-4067 or helpmegrowyubacounty.com during the screening if you have questions, want additional information on Help Me Grow, or need assistance filling out the screen.

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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 (2019-03-24) I screened my child and am entering in the responses to a previous screening

After you complete the screening, a Help Me Grow Care Coordinator will follow-up with you by telephone regarding the results. By clicking the “Submit” button below and entering your child's information into the online screening tool, you are agreeing to the following:

“I authorize this information about my child to be shared with Help Me Grow Yuba County (Yuba County Public Health & First 5 Yuba).”

“I authorize Help Me Grow Yuba County to share this information with the affiliated community agencies below, for the purposes of care coordination only. I understand that my child’s information will only be shared if a concern is found and I provide verbal consent for this information to be released to a community agency below.”

“I acknowledge that I have read and understood the ASQ Family Access End User License Agreement and agree to its terms and conditions.”

“I understand this agreement will be revoked after 1 calendar year, unless otherwise specified in writing.”

If you have any questions or you wish to participate in the developmental screening program without clicking “Submit”, contact Help Me Grow Yuba County at (800) 794-4067 or helpmegrowyubacounty.com for alternative arrangements.

Affiliated Community Agencies:

Yuba County Office of Education, Children’s Home Society, Ampla Health, Alta CA Regional Center, Peach Tree Health, Sutter-Yuba Behavioral Health, Family SOUP, Sutter North Brownsville, Sutter Infant Program, Childcare Planning Council, E Center Head Start, Marysville Pediatric Clinic, Harmony Health, Easter Seals, First 5 Yuba, Yuba County Public Health

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