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Welcome and thank you for your interest in learning more about your child's development! Please follow the instructions below to complete your child's screening.

Because your child's first 5 years of life are so important, we want to help you to provide the best start for your child. The Ages & Stages Questionnaire is a great way for you to help keep track of your child's development. You will be asked to anwer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving and personal social skills.

If you have questions about completing the screening, please feel free to call Help Me Grow at 650-762-6930.

Please note that this free screening is available only to residents of San Mateo County, California. Thank you to our funder First 5 of San Mateo County for making this possible for county residents.

If you live in another county or state please contact your child's pediatrician for developmental guidance.

Child Date of Birth

Month Day Year

Weeks Premature
(put "0" if not premature)

Screening Date

I am screening my child today (11-23-2024) I screened my child and am entering in the responses to a previous screening

List others assisting with completion of the questionnaire

By clicking submit, you acknowledge that you have read the provided information about the Ages & Stages Questionnaires (ASQ-3).

Your information will be shared with the San Mateo County Office of Education and their evaluators to improve understanding of the impact of developmental screening services in the community. Only a few authorized individuals will be able to see your screening information and they are not allowed to share your private information with anyone.

You also agree to receive information from Help Me Grow with the results of the 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.