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

By clicking submit, you acknowledge that you have read the information provided about Ages and Stages Questionnaires (ASQ-3) and you will complete the questionnaires regarding your child's development and will return the completed questionnaires via the online questionnaires completion program. 

You also agree to receive information from The Southern Illinois Coalition for Children and Families relative to the findings of this screening.

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.