Health Department of Northwest Michigan

220 W. Garfield

Charlevoix, MI 49720

www.nwhealth.org

1-800-432-4121

info@nwhealth.org

The Health Department of Northwest Michigan is committed to ensuring that all children from birth through age 5 receive routine developmental screenings. The Ages & Stages Questionnaire-3 (ASQ-3) and the Ages & Stages-Social Emotional Questionnaire (ASQ-se) are screening tools that ask questions about your child’s development. You will be asked to answer questions about your child. The questionnaire will take about 10-20 minutes to complete.  We will review your child’s results and get back to you by email, mail, or phone within one week.

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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)

Participation in this project is voluntary and at no cost to you.  Information you share will be kept confidential and will not be shared outside of the Health Department’s Universal Developmental Screening Program.  By completing this screen, you are agreeing to enroll your child in the Universal Developmental Screening program. Enrollment means you will periodically be sent an email reminder that it is time to complete a new screen.

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.