ASQ Online

Capstone Clinic
907-694-9553
17025 Snowmobile Lane
Eagle River, Alaska 99577

Welcome to our ASQ Online screening program!

Because your child’s first 5 years of life are so important, we want to help you provide the best start for your child.To help achieve this goal, we provide the Ages & Stages Questionnaires to help you keep track of your child’s development.You will be asked to answer questions about some things your child can and cannot do.

Please take 10-15 minutes to complete the questionnaire with your child to the best of your ability.

Note: your provider will not be able to meet with you unless the questionnaire is finished

Child Date of Birth
Format: yyyy-mm-dd
Child DOB you entered is in the future, are you sure of that? (Please correct the date before proceeding to the next step). Please enter your child's DOB and not the screening date or today's date (Please correct the date before proceeding to the next step). Child DOB you entered is not valid, please format the date like this: YYYY-MM-DD

Weeks Premature
(put "0" if not premature)

Screening Date I am screening my child today (2023-03-28) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

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.