Community Health Programs, 442 Stockbridge Road, Great Barrington, MA 01230

Welcome to our ASQ Online screening program!

The first 5 years of your child’s life are so important that we want to help you provide the best start for your child. As part of this service, we offer the Ages & Stages Questionnaire (ASQ) for FREE. The ASQ is a quick screening tool that provides a quick look into your child’s important developmental areas such as speech, physical ability, social skills and problem solving skills. You will be asked questions to identify areas of strength as well as areas that may need some support. 

 

 

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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 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.

 

Below is the ASQ consent form, by clicking the submit button you are agreeing to the consent form.

 

 

Dear Parent/Guardian,

 

 

   

The Massachusetts Department of Early Education and Care (EEC) and Community Health Programs would like to invite you to engage in developmental screening with your child using the Ages and Stages Questionnaire (ASQ). Developmental screening provides families the opportunity to share and learn about their child’s development, to celebrate their growth, and to address any questions or concerns they may have about what “typical” development looks like.




The ASQ is designed to be filled out by families. It is user-friendly, and should only take about 10 minutes to complete. It can be filled out on paper or online. Your child’s early education and care program can also do it with you in person, and provide you with the results.

The Consent Form below requests your permission for you to engage in developmental screening with your child, and to have your child's screening data entered into an online database. Using that data, your child’s early education and care program can look at your child’s development, and can connect you with community resources to support your child, if needed.

The Consent Form also requests your permission to share the data with EEC. The combined data from developmental screening across the Commonwealth helps inform the ways EEC supports educators and families to respond to children’s needs through training and resources. Please note that EEC will combine the data of many children and will not be able to identify specific individual children. Screening data will be confidential to ensure your privacy. If you do not wish to have information entered online and shared with EEC, you may decline this option and your child may still be screened using the ASQ paper questionnaire.

If you choose to participate in any of these developmental screening activities, please complete the Consent Form below. Thank you!

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

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.