Family Futures
616-454-4673
Connections@familyfutures.net
678 Front Ave NW - Ste 210
Grand Rapids, Michigan 49504
http://www.familyfutures.net

Thank you for participating in the Connections program of Family Futures!

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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)

I will let Family Futures share my ASQ results and other information with their partners to build a stronger circle of support for my family. I will let Family Futures share information with funding providers. If you are a Kent County resident, this includes theĀ Ready by Five Millage Consent. I will let Family Futures use my information for basic research. Family Futures will not print information that could identify my child in any public reports. This agreement does not have an end date. I can stop Family Futures from sharing my information at any time and for any reason by sending a written letter. Doing this will not change services received.

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.