Dr. Anne Pediatrics
972-304-0091
office@drannemd.com
150 S Denton Tap Rd Ste 116
Coppell, Texas 75019
www.DrAnneMD.com

Welcome to Ages and Stages online Questionnaire for young children.  This page is sponsored by Dr. Anne Pediatrics and is for the sole use of our patients.  If your child is not a patient and you would like your child to become a patient at Dr. Anne Pediatrics, please call our office at 972-304-0091 to schedule an appointment.

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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)

By completing this online questionnaire, you assert that you are the caregiver for the patient for whom you are completing the questionnaire, and you are authorized to provide information to Dr. Anne Pediatrics.

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.