Help Me Grow Sacramento
(916)822-8744
support@helpmegrowsac.org
helpmegrowsac.org

Welcome to our ASQ Online screening program!

The screening tool you will be completing via this link is the Ages and Stages Questionnaire (ASQ). This Screening tool measures 6 domains of development: Communication, Problem Solving, Fine Motor, Gross Motor and Personal/Social. This tool will give you a well rounded picture of your child's development. If you are also interested in screening on Behavior and Social Emotional skills, you are also welcome to complete the ASQ-SE which can be found on our webpage.

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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. By completing this questionnaire, I agree to have Help Me Grow staff contact me to follow up to ensure that any questions or concerns I may have are met.

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.