Easterseals National Office
toll free: 1-800-221-6827
screening@easterseals.com
141 W Jackson Blvd
Suite 1400A
Chicago, Illinois 60604
www.makethefirstfivecount.org


Welcome! Easterseals, through generous support from Comcast NBC Universal, is providing parents with free access to this online screening tool.

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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)

Results of the Ages & Stages Questionnaires (ASQ-3) will be sent within two weeks to the email address you provide through this registration process.

The Ages & Stages Questionnaires (ASQ-3) are designed for children birth through age five. If your child is age six or more, please discuss his or her development with your child's health care provider, your local school district, or your child's teacher.

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 Easter Seals, 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.