Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

Through Maine’s Office of Child and Family Services, Help Me Grow Maine offers families the option to share a copy of their child’s scored questionnaire with healthcare providers, schools, child care providers, or other community partners. This is a free and voluntary service that helps those who interact with your child provide more informed support and services. After you receive your child’s screening results, you will have the opportunity to choose which professionals or organizations, if any, you would like us to share this information with. No personally identifiable information will be shared without your consent.

In addition, Help Me Grow Maine may share summary, de-identified developmental screening data to support Maine’s broader public health efforts. Individual children cannot be identified through this shared data.

By continuing, you acknowledge that you have read the provided information about the Ages & Stages Questionnaires and consent to have your child participate in the online screening program.

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.