Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

I have read the provided information about the Dakota County Follow Along Program, and I wish to enroll my child in the online screening program.  This program will be available to me from birth to 5 years of age.  I will be informed of my child’s screening results after a questionnaire is completed. If the there are additional questions or concerns, a professional will contact you to review the results and discuss next steps. The Dakota County Follow Along Program would like you to be aware of how your private data will be collected. You can view the data privacy notice here.

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