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Track your child's development with ASQ-SE!

As children develop we often hear of a focus on their motor skills, language, and problem solving. The ASQ-SE offers additional insight into a childs behavior, with a focus of managing feelings, expressing emotions and having the ability to get along with others. The ASQ-SE is an easy to use resource for parents, caregivers and healthcare providers.

You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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.

Your information is secure and only accessible to program staff who will follow up with you with the results.

We look forward to your participation in ASQ:SE-2!

First 5 Siskiyou Children and Families Commission

Phone: 530.918.7222

https://first5siskiyou.org/help-me-grow-siskiyou/

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

Screening Date

I am screening my child today (05-15-2026) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

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.

I understand that by completing the Ages & Stages Questionnaire, I am giving consent for my child's results to be shared with their preschool teacher or childcare provider upon their request.

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.