Pediatricians Interactions
847-223-7433
[email protected]
649 Barron Blvd
Grayslake, Illinois 60030

Pediatric Interactions values your commitment to your child's development.  We are honored to provide a developmental screening for your child.  Please complete the  Ages & Stages Questionnaires, Third Edition (ASQ-3), online screening prior to your scheduled appointment.  The questionnaire includes a set of questions about some things your child can and cannot do in the areas of communication, gross motor, fine motor, problem solving, and personal social skills.  We have found many children "perform" these tasks in the comfort of a familiar environment with a parent or caregiver more consistently than they may do at the screening appointment.  

A developmental screening is not intended to be an evaluation, but an opportunity for families to receive some education and guidance on their child's development, next steps or recommendations and activities to help promote their skills.

This questionnaire must be completed prior to your child's appointment so that the screening therapist can review the results and recommendations with you.  If the information is not received a day prior to your scheduled appointment, it may be rescheduled.  Please contact us if you are unable to keep your scheduled appointment or if you have any questions.



(put "0" if not premature)



I have been provided with Pediatric Interactions' Privacy Notice.  I wish to have my child participate in an online screening by filling out the questionnaire about my child's development and promptly submitting the completed questionnaire through this Family Access online questionnaire completion system. I understand that if my child is participating in a developmental screening in collaboration with his/her preschool/daycare, these results may be shared with staff to help facilitate your child's needs at home and school.  I understand if this information is not provided one day prior to my child's scheduled appointment, it may be rescheduled.  

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.