Help Me Grow Fox Valley
[email protected]
First 5 Fox Valley
1001 W. Kennedy Ave. Suite C
Kimberly, Wisconsin 54136

Welcome to our ASQ Online developmental screening program!

Help Me Grow Fox Valley is working with a variety of community partners to provide you and your family with information and resources related to child development and parenting. Help Me Grow, along with First 5 Fox Valley, provides personal resource coordination and facilitates partnership within the community to improve the availability and quality of services to families. We are offering free developmental screenings because of the generous donations of local community partners.

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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: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development. The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

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:SE-2!

(put "0" if not premature)

Help Me Grow Ages and Stages Online Questionnaire

A unique feature of the Help Me Grow system is that we are able to share a copy of the scored questionnaire with your child’s healthcare provider, school, child care provider, and community resource partners if you wish.  This is a free and optional service that allows you to work cooperatively with those who interact with your child so they can offer higher quality support and services.  Once you receive the results, you will be given the opportunity to provide the name and contact information of any organization or professional with who you would like us to share this information.  No information will be shared without your consent. You can read more information about our consent and use of data policy.

 Privacy Policy and Consent to Use of Data

I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online screening program. I will fill out the questionnaire about my child's development and promptly submit the completed questionnaire through this Family Access online questionnaire completion system.

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.