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2800 W Central Rd
Rolling Meadows Illinois 60008


(put "0" if not premature)

Screening Date Options

For ASQ-3™ English

Screening Date Selection

For ASQ:SE-2™ English

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.