Help Me Grow at 211 HelpLine
561-533-1098 OR 561-533-1097
211HMG@211pbtc.org
P. O. Box 3588
Lantana, FL  33465

We invite you to complete a developmental questionnaire for your child.  211 HelpLine is an affiliate Help Me Grow program available in Florida to provide developmental monitoring for children birth to age 5 1/2.  Skills such as talking, moving, playing and learning self care are called developmental milestones.  These milestones are important as your child learns about the world and starts to learn.

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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)

 

When you click on the SUBMIT button you are agreeing to participate in the ASQ screening program.

 

 I have read the provided information about Help Me Grow and the Ages & Stages Questionnaires and I wish to  participate in the 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.