landing page logo

Welcome Family of Pediatric Neurology of Lehigh Valley! You are about to access our ASQ Online screening and monitoring program!

This questionnaire includes questions about your child’s ability to calm down, follow directions, demonstrate feelings, and interact with others. The SE-2 is offered every 6 months until your child is 3 years old, and then again at 4 years old and 5 years old.

Select a time your child is happy, alert, and ready to play. Make it a game and you’ll both have fun! If completing this questionnaire brings up any questions or concerns, please don’t hesitate to contact me.

We look forward to your participation in our program.  Have fun completing this questionnaire with your child. Please call or email me at any time if you have any questions or would like to discuss any concerns about your child’s development.

Regards,

Melissa Vandever

Child Development Specialist

Easterseals Eastern PA-Lehigh Valley

www.easterseals.com/esep

[email protected]

P: 610-289-0114 x230

Sara Moreno-Alicea

Bilingual MtFFC Specialist

Easterseals Eastern PA-Berks

www.easterseals.com/esep

[email protected]

C: 717-926-4960

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

Screening Date

I am screening my child today (05-06-2025) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

Consent

*I have read the provided information about the MtFFC screenings. I wish to have my child participate in the screening and monitoring program.

*I have read, understand, and agree to the online consent. Please complete the consent here if you haven’t already: ESEP consent with PNLV

*I have received a copy of the HIPAA statement: ESEP HIPAA

*I agree to be contacted by an Easterseals specialist, who will share the results with me and also give me activities and/or connect you to community resources in line with my child’s individual needs.

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.