South Royalton Health Center
(802)763-7575
srhc@srhealthcenter.net
79 South Windsor Street, P.O. Box 119
South Royalton, Vermont 05068
https://www.srhealthcenter.com/



(put "0" if not premature)

For ASQ-3™ English

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By proceeding with this questionnaire, you agree to allow South Royalton Health Center to review your answers and follow up with you directly. South Royalton Health Center will communicate screening results and other basic information about your family with other service providers when appropriate.

Additionally, in partnership with Help Me Grow Vermont, South Royalton Health Center shares developmental screening information with others to provide an overall view of how Vermont’s children are doing and to coordinate support. By clicking “Submit” you are agreeing to share your child’s information and screening results as outlined in the Authorization for Release and Disclosure of Developmental Screening Results. This authorization is voluntary. 

For more details, or if you do NOT wish to participate in this online developmental screening program, please contact us.

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.