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Welcome to Associated Physicians’ Ages and Stages Questionnaire!

The first 5 years set the stage for success in school and later life. During infancy and early childhood, you child will gain many experiences and learn many skills. Because this time is so important, we use a special questionnaire to help gauge your child's current level of development. This questionnaire will help your physician and nurses to better understand how your child is developing and identify any potential concerns. Your answers will be available when you meet with your doctor and will help to generate important discussion that will promote the best possible care for your child’s individual needs.

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!

Child Date of Birth
Format: yyyy-mm-dd

Weeks Premature
(put "0" if not premature)

Screening Date

I am screening my child today (2024-04-18) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

Please read the text below and click “submit” if you consent to proceed with the questionnaire.

I have read the provided information about the Ages & Stages Questionnaires (ASQ-3), and I wish to have my child participate in the monitoring program. I will fill out the questionnaires about my child’s development and submit my responses through the 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.