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Early Intervention / Early Childhood Special Education
503-675-4000
13455 SE 97th Ave
Clackamas, Oregon 97015
www.clackesd.org

Welcome to our ASQ Online questionnaire!

Completing the following Ages & Stages Questionnaires, Third Edition (ASQ-3) will provide valuable information about your child's development. 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.

Thank you for your participation!



(put "0" if not premature)



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.