A To Z Building Blocks - CC
801-763-0722
Atozbuildingblocks@gmail.com
195 N 100 E
American Fork, Utah 84003

Welcome to the Utah Department of Health's, Ages and Stages Questionnaire® (ASQ) program; in partnership with A to Z Building Blocks!!

Thank you for taking the time to complete this questionnaire.  A to Z Building Blocks is a place where children are loved, taught and given opportunities to grow.  Assessing children is a great tool to know where we can better serve our families!

We feel that the early years of a child are very critical to a child's life.  By participating in this assessment tool we will be able to work together to make sure that your child is developing the way he/she is supposed to.  Completing this questionnaire gives A to Z Building Blocks permission to conduct assessments with your child too.  A to Z Building Blocks will make the parent fully aware of any concerns and provide additional resources to seek further help.  A to Z Building Blocks will not diagnose any special need and will only refer you to outside sources.

This developmental screening opportunity is provided by the Utah Department of Health (UDOH). UDOH partners with early care and education providers, to ensure all families with young children have access to developmental screening.

 

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-SE!



(put "0" if not premature)

IMPORTANT: By submitting data and/or using this website, you give your consent to the use of your personal data and developmental screening data as described in the UDOH Privacy Policy and Consent to Use of Data.

If you do not wish to share data, do not enter data into ASQ online. Please let A-Z Building Blocks know and they will provide you with a paper copy of the ASQ.

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.