ABC Pediatrics
828-277-3000
[email protected]
64 Peachtree Rd. Suite 100
Asheville, North Carolina 28803

ASQ-3 is a set of questionnaires about children’s development. It has been used for more than 20 years to
make sure children are developing well. It is called a screener because it looks at how children are doing in
important areas, such as speech, physical ability, social skills, and problem-solving skills. ASQ-3 can help
identify your child’s strengths as well as any areas where your child may need support.
As a parent or caregiver, you are the best source of information about your child.
Please fill out the appropriate age related screening and bring it to your next appointment.

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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)


I hereby authorize ABC Pediatrics to maintain this information about my child.

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