Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ-3™ English

List others assisting with completion of the questionnaire

What Happens Next?

Once you submit the ASQ, you will be emailed feedback within one week to celebrate your child's milestones. Also, you will find learning activities on the thank-you page. These are fun activities and games you can do with your child to boost their social and emotional development.

If you express any concerns or the ASQ indicates a possible concern, we will discuss your options for next steps. 

Thank you for participating in the ASQ:SE!

Parent/Guardian Consent: By completing an ASQ online you are giving consent for the Early Childhood Community Coordinator of United Way of Mason County to review your child's results and provide you with the score from the screening. All of the information you enter into this website is secure and cannot be seen by anyone other than the Early Childhood Community Coordinator. United Way of Mason County will look at the data from all of the screenings collected to better understand the needs of young children in our community.

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.