El Dorado Community Hub 1
www.eldoradocommunityhubs.com
Jaclyn Raya - Community Hub Navigator and Family Specialist
530-503-5626 or [email protected]



(put "0" if not premature)

Screening Date Options

For ASQ-3™ English

Screening Date Selection


For ASQ:SE-2™ English



I give consent:

I have read the provided information about the Ages and Stages questionnaires, and I wish to have my child participate in the online screening.

I give consent to the El Dorado County Office of Education (EDCOE)/Community Hub to share the ASQ Questionnaire and results summary with The Gift of Kids.

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.