Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

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.

Help Me Grow WNY (HMGWNY) and our partners use the ASQ Online system to review and store early childhood developmental screening data. HMGWNY is committed to keeping your data safe, secure, and private. ASQ Online uses robust security measures and employs the appropriate physical and technical safeguards to protect user data, child data, and other data entered by users in the ASQ Online system and ensure over time their continued confidentiality and correct use. The ASQ Online system is compliant with Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) federal laws. By completing your child’s screening using the ASQ Online system, you consent for this information to be stored and archived within the system. To learn more, visit https://agesandstages.com/resource/asq-online-technical-information-security-features-and-hipa a-ferpa-compliance/.

HMGWNY will never share your child’s individual results with any of your child’s providers unless you provide written consent. Anonymous data is compiled into an online dashboard that can be accessed from our website at www.hmgwny.org under “Community Dashboard” to look for trends in child development that should be addressed at a community level.

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.