Brighton Center
(210)826-4492
ecireferrals@brightonsa.org
14207 Higgins Rd
San Antonio, Texas 78217
www.BrightonSA.org



(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. 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. I understand that the information entered into this website is secure and cannot be seen or accessed by anyone other than the porgram employees who have invited you to participate in this 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.