Brookes ASQ | ASQ:SE2 - ASQ-3 English

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Why screenings Matter?

Screening young children is an effective, efficient way for professionals to check a child’s development, help parents celebrate their child’s milestones and know what to look for next, and determine whether follow-up steps are needed. It’s also an essential first step toward identifying children with delays or disorders in the critical early years, before they start school.

For Developmental Milestones click ASQ 3

For Social Emotional screening Click ASQ: SE

Any questions? Visit our website Help Me Grow or give us a call

Help Me Grow Program

2300 SW 17th Rd

Ocala, FL 34471

Telephone: (352) 369-2315 Ext. 225 or Ext, 227 Fax: (352) 369-2308

Email|Web: [email protected] | www.elc-marion.org

ELCMC hours of operation are: Monday-Thursday 7:00 AM- 5:00 PM and Friday 7:00 AM – 3:30 PM.

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

For ASQ-3™ English

Screening Date

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

Screening Date

List others assisting with completion of the questionnaire

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.

Disclaimer Message

I agree to the following terms and conditions.

By using the portal, you agree that a representative from Help Me Grow Florida (hereinafter, collectively, Help Me Grow), its agents or authorized delegates, may use the personal information which has been provided by you related to the minor child. You certify that you are either (1) the parent or legal guardian of the child and is authorized to consent to the use of such information by Help Me Grow OR (2) that you are not the primary caregiver and understand that the child’s parent or guardian will be contacted for their permission to proceed with this referral and that no action will be taken on this referral until the consent of the child’s parent or guardian is received.

You understand that Help Me Grow DOES NOT provide medical advice pertaining to the child's health or well-being and that the use of website does not create a Doctor-Patient, or any other legally recognized relationship between you, the user of this website, your minor child and Help Me Grow. THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE OR TREATMENT.

Every effort will be made to keep the information you provide confidential. By using this website, you expressly agree that Help Me Grow, on behalf of its agents and employees, may use any submitted information as they deem appropriate to achieve the purposes of this website.

Help Me Grow will make referrals to individuals and entities it deems appropriate and qualified. However, Help Me Grow makes no representations or warranties, express or implied, regarding any services that are rendered to you or your minor child by any individual or entity to which you are referred.

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.