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Welcome to Help Me Grow Inland Empire’s screening and monitoring program. Because your child’s first 5 years of life are so important, we want to help you provide the best start for your child.

As part of this service and for children ages 0-5, we provide the Ages & Stages Questionnaires, Third Edition (ASQ-3), to help you keep track of your child’s development and the Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2), to help you keep track of your child’s social-emotional development.

If while completing the questionnaires you have any questions, please feel free to contact us.

If you have an older child ages 5.5 to 8 years and you have questions about their growth, please call us to speak with a Help Me Grow Inland Empire Program Coordinator.

Help Me Grow Inland Empire
Phone: 1(888) 464-4316 or 1(888) HMGIE-16
Email: [email protected]
Website: www.HelpMeGrowIE.org

Welcome to Help Me Grow Inland Empire’s screening and monitoring program!

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!

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

Screening Date

I am screening my child today (02-05-2025) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

Authorization for Participation and Sharing of Personal Information

By submitting answers to this questionnaire, I understand and acknowledge that:

My participation or the participation of my child in the Help Me Grow Inland Empire program is voluntary.

The information I am voluntarily providing on these questionnaires to Help Me Grow Inland Empire will be used internally and also shared with third party entities such as, but not limited to, my child’s early childhood educator and my child’s medical or behavioral health provider in order to assess my child for developmental delay and to link my family to community resources.

I have the right to discontinue participation on this program or limit the disclosure of my information at any time by submitting my request in writing to Help Me Grow Inland Empire, Compliance Manager, 11234 Anderson Street, Suite CH1816, Loma Linda, CA 92354. I understand that the revocation will not apply to information that has already been released in response to this authorization. Unless otherwise revoked, this authorization will remain valid.

I have read the above statements and I am at this time authorizing Help Me Grow Inland Empire to use and disclose the information provided on this questionnaire as Help Me Grow Inland Empire, its affiliates, subcontractors, and its representatives deem appropriate in order to provide my child and my family with developmental screening tools and community resources.

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.