Help Me Grow South Carolina
1 Carriage Lane
Unit J
Charleston, South Carolina 29407

(put "0" if not premature)

For ASQ-3™ English

For ASQ:SE-2™ English

Questionnaires should be completed by the child's parent or legal guardian.


By proceeding with this form, you agree to allow Help Me Grow South Carolina to review your answers and use your information as is consistent with our Privacy Policy and Consent to Use of Data, which is posted on our website:


In addition, we would like to send a copy of the scored questionnaire to your child's health care provider. This is a free service, and allows you to work interactively with your health care team so they can offer better care to your family. If you do not wish to receive this service, please contact us at [email protected], and we will remove this permission from your file.

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.