Easterseals DuPage & Fox Valley
630-620-4433
[email protected]
830 S Addison
Villa Park, IL 60554
www.AskEasterSeals.com

Welcome to our ASQ Online screening program!

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: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development.

The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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.



(put "0" if not premature)



By clicking submit, you acknowledge that you have read the provided information about the Ages & Stages Questionnaires (ASQ-3), will complete the questionnaires regarding your child’s development and will return the completed questionnaires via the online questionnaire completion system.

You also agree to receive information from Easterseals relative to the results of the screening as well as periodic information about our work.

Finally, you agree to the Notice of Privacy Practices of Easterseals, Inc. that can be found here.

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.

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