Brookes ASQ

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Help Me Grow WNY
(716) 462-4108
gsmith@hmgwny.org
1170 Main Street
Buffalo, NY 14209
www.helpmegrowny.org

Welcome

Help Me Grow WNY's mission is to promote the optimal development of young children by:

· linking families to information and community resources related to child development and parenting
· providing personalized care coordination
· creating and facilitating partnerships within the community to improve the availability and quality of services for families

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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 (2019-06-16) I screened my child and am entering in the responses to a previous screening

A unique feature of the Help Me Grow system is that we are able to share a copy of the scored questionnaire with your child's healthcare provider, school, child care provider, and community resource partners if you wish. This is a free and optional service that allows you to work cooperatively with those who interact with your child so they can offer higher quality support and services. Once you receive the results, you will be given the opportunity to provide the name and contact information of any organization or professional with whom you would like us to share this information. No information will be shared without your consent.

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.

ASQ :: Ages & Stages Questionnaires