Ages & Stages727-233-8291[email protected]15506 County Line Rd.Suite 104Spring Hill, Florida 34610www.phelc.org
Child Date of BirthFormat: 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)
List others assisting with completion of the questionnaire
Our new online ASQ system allows us to save paper and time.
PLEASE USE YOUR CHILDCARE CENTERS ADDRESS WHEN ENTERING AN ADDRESS FOR CHILD'S INFORMATION.
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