Child Date of Birth
Format: yyyy-mm-dd
Child DOB you entered is in the future, are you sure of that? (Please correct the date before proceeding to the next step). Please enter your child's DOB and not the screening date or today's date (Please correct the date before proceeding to the next step). Child DOB you entered is not valid, please format the date like this: YYYY-MM-DD

Weeks Premature
(put "0" if not premature)

For ASQ-3™ English

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

What happens after I complete the questionnaire?

The results will be sent to the Early Childhood Department at the Ottawa Area Intermediate School District  to be reviewed. In a day or two you will be sent individualized feedback to help celebrate your child's developmental milestones and receive  fun ideas to continue to support their development!  If you have concerns or the ASQ  indicates a possible concern, you will be provided with resources and contacts to help address them.

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