Goodwill Easter Seals
660 S Main St
Dayton, Ohio 45402

Welcome to our ASQ Online screening program! The Goodwill Easter Seals Miami Valley Child Screening Program is open to Ohio residents in the following counties:  Clark, Darke, Greene, Miami, Montgomery, Preble, Shelby, and Warren 

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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)

I am the legal guardian and/or parent of this child.  I have read the provided information about the Ages & Stages questionnaires and I wish to have my child participate in the online screening program. Goodwill Easter Seals Miami Valley (GESMV) Child Screening Team has permission to contact me regarding my child's screening results through email, mail, and/or phone.  It is the parent/guardian's responsibility to pursue follow-up with area agencies if further developmental assessment is recommended based on your child's screening results. The GESMV screening team will provide contact information and resources for these local agencies and services. IN THE EVENT OF A SUSPECTED DELAY OR CONCERN, GESMV has permission to submit a copy of your child's completed ASQ to your child's listed pediatrician (if consent and contact information is provided on this website).  

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.