Clinic:  Kiwi Pediatrics
Phone:  (403) 281-2500
Address:  #224, 11420 - 27th Street SE
Calgary, Alberta T2Z 3R6
Website:  http://kiwipediatricscalgary.com/

Dear Parent/Caregiver,

Welcome to the start page for ASQ screening for Kiwi Pediatrics!

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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)

By completing this form, you consent to the results being viewed by our clinic staff and/or you child's pediatrician who will treat the results confidentially.

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.