Cherry Creek Pediatrics
303-756-0101
[email protected]
4900 E Kentucky
Denver, Colorado 80246

Thank you for participating in your child's well visit developmental screening. The developmental screen will be scored and discussed with you at your upcoming well visit.

NOTE:
PLEASE DO NOT COMPLETE THE DEVELOPMENTAL SCREEN UNLESS YOU HAVE A WELL CHILD EXAM SCHEDULED WITHIN THE NEXT TWO WEEKS

YOU MAY SKIP STEPS 1 AND 2 TO AVOID PRINTING THE QUESTIONNAIRE.

 

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Because your child's first 5 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 may be provided every 2-, 4- or 6-month period. You will be asked to answer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills.

Please enter your child's birth date and the number of weeks he or she was born premature below to start the screening. Please note that the information you enter into this website is secure and cannot be seen or accessed by anyone other than the program employees who have invited you to participate in this screening.

We look forward to your participation in ASQ-3!



(put "0" if not premature)


Your screen will be used only for direct patient care at your upcoming well visit.

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.