Help Me Grow South Carolina
1 Carriage Lane
Unit J
Charleston, South Carolina 29407
www.helpmegrowsc.org

Welcome to the Ages and Stages Questionnaire for Help Me Grow South Carolina.  This is a fun and interactive way for you to learn about and promote your child's healthy development. 

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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)


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: https://helpmegrowsc.org/privacy/.

 

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.