Brookes ASQ | ASQ:SE2 - ASQ-3 English

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Track your child's development with ASQ-3!

The first five years are full of incredible milestones, and First 5 is here to support in giving your child the best start. The Ages & Stages Questionnaires (ASQ-3) help you keep an eye on important developmental areas like communication, motor skills, problem-solving, and social interactions.

It’s simple: answer a few questions about what your child can do, and check in every few months to see their progress. Your information is secure and only accessible to program staff who will follow up with you with the results.

Start your child’s screening today and support their journey!

Receive one $10 giftcard upon completion of the the first screening you complete.

First 5 Siskiyou Children and Families Commission

Phone: 530.918.7222

https://first5siskiyou.org/help-me-grow-siskiyou/

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

For ASQ-3™ English

Screening Date

I am screening my child today (2025-09-16) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

Screening Date I am screening my child today (2025-09-16) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

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.

I understand that by completing the Ages and Stages Questionnaire I am giving consent for my child's results to be shared with their preschool teacher or child care provider upon their request.

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.