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

Participation in this screening is voluntary and at no cost to you. By proceeding with this form you agree to allow Help Me Grow Michigan and its affiliates to review your answers. One of our care coordinators will follow up in the next 3-5 days with your results and activities to support your child's development. With your permission, we may also share your results with your local early childhood support system to ensure your child's needs are met. Your child's non-identifying information will be combined with others in this program, and the data will be studied to help improve access to services for all children in Michigan.

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