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.

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.