FDLRS Sunrise
863-535-6486
poinsetta.tillman@polk-fl.net
1860 E Gibbons St Bartow, FL 33830
Bartow, Florida 33830

Welcome to our ASQ Online screening program!



(put "0" if not premature)

I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online screening program. I will fill out the questionnaire about my child's development and promptly submit the completed questionnaire through this Family Access online questionnaire completion system.

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.