Children's Health Partners, SC

630-848-1700

2007 95th St., LL-A

Naperville, IL  60564

childrenshealthpartners.com

Welcome to our ASQ Online screening program!  Because your child's first 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 includes questions about your child's communication, gross motor, fine motor, problem solving and personal social skills.  Please enter your child's name, DOB, and number of weeks premature and choose "I am screening my child today,"  and click on Submit.  You will be given the option to print the questionnaire and work with your child prior to answering the questions online.  We ask that you complete the questionnaire and submit it at least 3 days before your child's next well visit.  Any questions or concerns will be discussed at that visit.  Once you've completed the questionnaire you'll be given the opportunity to view/print age appropriate learning activities that you can do with your child at home, by choosing "Click here for further information."



(put "0" if not premature)

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.

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.