ELC OF DUVAL - DEVELOPMENTAL SCREENING
904-208-2044, EXT. 253
[email protected]
6500 BOWDEN RD, SUITE 290
JACKSONVILLE, FLORIDA 32216



(put "0" if not premature)

For ASQ-3™ English


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 questiionnaire system. I give permission to ELC of Duval Developmental Health Department to share screening results and referrals (if given) with my child's pediatrician. Participation in this project is voluntary and at no cost to you. 

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.