Early Learning Institute
707-591-0170

If you are not a resident of Sonoma County, please reach out to your local medical provider to find a screening location.

The ASQ-3 includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills and can help you identify your child’s strengths. The screening questionnaire will also highlight any areas of concern, should there be any.

The ASQ-SE questionnaire targets social-emotional and behavioral development. It is also observation based, highlighting strengths or potential areas of concern.

If you would like to complete both please click on:  I am completing both the ASQ-3™ and ASQ:SE-2™ questionnaires.  

Once completed, ELI’s Developmental Specialists will score the results and contact you within two business days for review. If indicated, possible next steps will be discussed, along with free activity suggestions.

In order for receive contact/follow-up/services from us, please enter an updated phone number and email address in the fields requested

 

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)

For ASQ-3™ English

Screening Date I am screening my child today (2024-05-20) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

Screening Date I am screening my child today (2024-05-20) 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.