Passaic County - Partnership for Maternal & Child Health of Northern NJ
50 Union Ave Suite 403
Irvington, NJ 07111
973-942-3630
[email protected]


Dear Parent/Caregiver,

Congratulations on taking steps to get a better understanding about your child’s growth and development.

We are excited about your interest in this online screening tool to help you keep track of and learn about your child's development. The Ages & Stages Questionnaires, (ASQ-3), can be used by families living in Passaic County with any child from age 1 month to 5 years. The questions ask about some things your child can or cannot do. There are questions about your child's:

Communication:  How your child talks

Gross motor:  How your child plays

Fine motor:  How your child uses their hands

Problem-solving:  How your child learns

Personal/Social Skills:  How your child interacts with their world

Within a few days after we receive your completed ASQ-3, we will contact you to share the results and offer follow-up activities and resources.


To use this online screening tool, begin by entering your info below and clicking "submit”.

We look forward to your participation in ASQ-3!

Sincerely,

Partnership for Maternal & Child Health of Northern NJ (a Program of Help Me Grow NJ)

The Weeks Premature field below refers to how many weeks early your child was born.  Based on 40 weeks being full term, if your child was born at 36 weeks or earlier be sure to put in how many weeks early.  Example: If your child is born at 35 weeks, put in 5 weeks; if your child is born at 32 weeks, put in 8 weeks.

If you have any questions, please be sure to contact us at: 973-942-3630



(put "0" if not premature)



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.

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