{Help Me Grow North Texas}
844-689-5437
[email protected]
3840 S Hulen
Ft. Worth, Texas 76017



(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. 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

Prevention Early Intervention  

My Health My Resources (MHMR) Tarrant County

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