Brookes ASQ | ASQ:SE2 - ASQ-3 English

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Strathcona County Family Resource Network
780-464-4044
[email protected]
2001 Sherwood Drive
Sherwood Park, Alberta T8A-3W7

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

For ASQ-3™ English

Screening Date

I am screening my child today (2024-11-22) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

Screening Date I am screening my child today (2024-11-22) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

Personal information is collected in accordance with section 3 of the Municipal Government Act and section 33 (c) of the Freedom of Information and Protection of Privacy Act (FOIP) and is protected by FOIP. It is used by Strathcona County Family Resource Network to score the Ages & Stages Questionnaire and report this information back to the child's parent. Aggregate information is reported to the program funders; no individual information is provided. If you have any questions about the collection and use of your personal information contact the Manager, Family Resource and Supports, Strathcona County at 780-464-4044.

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.