Alberta Parenting for the Future Association
780-963-0549
tracy@apfa.ca
The Family Connection Centre
5600 50 Street
PO Box 2695
Stony Plain, Alberta T7Z1B1
www.apfa.ca



(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

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.