Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ-3™ English

List others assisting with completion of the questionnaire

Participation in this project is voluntary and at no cost to you. Your child’s results are confidential and will not be shared outside of Help Me Grow-Oakland Early Childhood data system. Your child's non-identifying information will also be combined with that of others in this program for learning purposes. By completing the online ASQ, you give your consent to participate. We will send your child's results by email. Based on these results, we may contact you about early childhood services in which your child may be eligible. 

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