Capstone Family Medicine
907-357-9590
3122 E. Meridian Park Loop
Wasilla, Alaska 99654

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.To help achieve this goal, we provide the Ages & Stages Questionnaires to help you keep track of your child’s development.You will be asked to answer questions about some things your child can and cannot do.

Please take 10-15 minutes to complete the questionnaire with your child to the best of your ability. 

Note: your provider will not be able to meet with you unless the questionnaire is finished

 



(put "0" if not premature)

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.

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.