Brookes ASQ | ASQ:SE2 - ASQ-3 English

landing page logo

Welcome and thank you for your interest in learning more about your child's development! Please follow the instructions below to complete your child's screening.

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

For ASQ-3™ English

Screening Date

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

Screening Date

List others assisting with completion of the questionnaire

By clicking submit, you acknowledge that you have read the provided information about the Ages & Stages Questionnaires (ASQ-3).

Your information will be shared with the San Mateo County Office of Education and their evaluators to improve understanding of the impact of developmental screening services in the community. Only a few authorized individuals will be able to see your screening information and they are not allowed to share your private information with anyone.

You also agree to receive information from Help Me Grow with the results of the screening.

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.