Early Learning Institute
707-591-0170

If you are not a resident of Sonoma County, please reach out to your local medical provider to find a screening location.

The ASQ-3 includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills and can help you identify your child’s strengths. The screening questionnaire will also highlight any areas of concern, should there be any.

The ASQ-SE questionnaire targets social-emotional and behavioral development. It is also observation based, highlighting strengths or potential areas of concern.

If you would like to complete both please click on:  I am completing both the ASQ-3™ and ASQ:SE-2™ questionnaires.  

Once completed, ELI’s Developmental Specialists will score the results and contact you within two business days for review. If indicated, possible next steps will be discussed, along with free activity suggestions.

In order for receive contact/follow-up/services from us, please enter an updated phone number and email address in the fields requested

 

Child Date of Birth

Month Day Year

MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

Child DOB you entered is in the future, are you sure of that? (Please correct the date before proceeding to the next step). Please enter your child's DOB and not the screening date or today's date (Please correct the date before proceeding to the next step). Child DOB you entered is not valid, please format the date like this: MM-DD-YYYY

Weeks Premature
(put "0" if not premature)

Screening Date Options

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.

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.