Brookes ASQ

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Early Childhood Services

A part of My Health My Resources (MHMR) of Tarrant County

Welcome to our ASQ Online screening program!

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: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development. The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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-2!

Child Date of Birth
Format: YYYY-MM-DD
Child DOB you entered is in the future, are you sure of that? (Please correct the date before proceeding to the next step). Please enter your child's DOB and not the screening date or today's date (Please correct the date before proceeding to the next step). Child DOB you entered is not valid, please format the date like this: YYYY-MM-DD

Weeks Premature
(put "0" if not premature)

Screening Date I am screening my child today (2018-11-18) I screened my child and am entering in the responses to a previous screening

I have read the provided information about the Ages & Stages questionnaires and I wish to have my child participate in the online screening program. If I was referred by a child care center, I understand that my results will be shared with the center. I also understand de-identified results will be compiled and shared with other entities* for evaluative and research purposes.

**Other Entities may include, but are not limited to:

Early Learning Alliance

Department of State Health Services

University of Texas, Austin

Prevention Early Intervention

My Health My Resources (MHMR) Tarrant County

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.

ASQ :: Ages & Stages Questionnaires