Early Intervention (Birth to 3) Program
920-997-1484
[email protected]
2350 N. Casaloma Dr.
Appleton, Wisconsin 54913

Welcome to our ASQ Online developmental screening program!

Help Me Grow Fox Valley is working with a variety of community partners, such as the Early Intervention (Birth to 3) Program, to provide you and your family with information and resources related to child development and parenting. Help Me Grow, along with the Early Intervention (Birth to 3) Program, provides personal resource coordination and facilitates partnership within the community to improve the availability and quality of services to families. We are offering free developmental screenings because of the generous donations of local community partners.

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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!



(put "0" if not premature)



The Early Intervention Program partners with a new program in our community called Help Me Grow Fox Valley. The goal of Help Me Grow is to provide information and support to families who have young children.  They do not provide a direct service, but they can answer your questions, provide information and connect you with useful resources. 

Help Me Grow Ages and Stages Online Questionnaire

Information from the ASQ you complete today will be shared with Help Me Grow Fox Valley. The screening results will be stored in a database that many programs feed into, but your specific information will be kept private, only being accessed by the Early Intervention Program and Help Me Grow Fox Valley. The data that HMG collects gives us an overview of how children in the Fox Valley are doing and how well our programs work together to support families. You can read more information about our consent and use of data policy.

Privacy Policy and Consent to Use of Data

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.