Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ-3™ English

List others assisting with completion of the questionnaire

Personal information is collected under the authority of section 4(c) of the Protection of Privacy Act and will be used to manage and administer Strathcona County programs.  Personal information collected in this form will be shared with partner organizations and aggregated, anonymized information is reported back to the Government of Alberta for purposes of program funding and development. If you have questions regarding the collection, use or disclosure of this information, contact the Manager, Child and Family Wellbeing at 780-416-6730.

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