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Chatham Kent Child and Adolescent Clinic (CKCAC)
(519)358-1880
administration@ckcac.ca
202 King St. W
Chatham, Ontario N7L1E5
www.ckcac.ca

Welcome to the Chatham Kent Child and Adolescent Clinic "Ages and Stages" web page! Ages and Stages is a simple and widely used screen looking at developmental milestones for your child. Please note that this tool is to be used only by current patients of the clinic. Upon completion of the screen, the results will be forwarded securely to the clinic.

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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!

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 (2023-03-22) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

Completion of any of these questionnaires implies consent to have the test results forwarded electronically to the Chatham Kent Child and Adolescent Clinic. The results will become part of your child's medical record. The screen will not necessarily be reviewed by your health care provider until the next clinic appointment.

Please note that screens filled out by non-clinic patients will not be scored.

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.