Family Services of Central Alberta

5409- 50 Ave, Red Deer

T4N 4B7

403-309-8210

[email protected]



(put "0" if not premature)

For ASQ-3™ English


For ASQ:SE-2™ English


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.