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 understand that Ages & Stages questionnaires are a way for parents and caretakers to learn about their child's development and that completing the ASQ is voluntary. Results can be shared with my child care provider/program, if applicable.  Once the questionnaire is completed, I understand that First 5 Plumas will contact me.  

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