The Partnership for Maternal Child Health of Northern NJ - Union
50 Union Ave Suite 403
Irvington , New Jersey 07111
973-856-0575
[email protected]
pmch.org

Dear Parent/Caregiver,


Congratulations on taking steps to get a better understanding about your child’s growth and development.

We are excited about your interest in The Ages & Stages Questionnaire, (ASQ-3) online screening tool for families living in Camden County to help you keep track and learn about your child’s development. Screening results shows your child’s strengths and areas that may need support.

 

The questionnaire is provided from age 1 month to 5 years of age. Your child can rescreen every 2-4, or 6 month- period after completing his/her first developmental screen.

 

The questionnaire includes 30 questions in 5 developmental areas and ask questions about some things your child can or cannot do.  The questions are about your child’s:

 

Communication: How your child talks

 

Gross Motor Skills: How your child plays

 

Fine Moto Skills: How your child uses their hands

 

Problem-Solving Skills: How your child learns

 

Personal/Social Skills: How your child interacts with their world

 

Within a few days after we receive your completed ASQ-3, we will contact you to share the results and offer follow-up activities and resources.

 

To use this online screening tool, begin by entering your information below and clicking “submit”. If your child was born premature, please enter the number of weeks premature.

*Please note the information you enter in 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!

Sincerely,

Partnership for Maternal and Child Health of Northern New Jersey (a Program of Help Me Grow NJ)

The Weeks Premature field below refers to how many weeks early your child was born.  Based on 40 weeks being full term, if your child was born at 36 weeks or earlier be sure to put in how many weeks early.  Example: If your child is born at 35 weeks, put in 5 weeks; if your child is born at 32 weeks, put in 8 weeks.

If you have any questions, please be sure to contact us at: 201-876-8900 ext. 223



(put "0" if not premature)



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.

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