Weeks Premature
(put "0" if not premature)

List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

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), will complete the questionnaires regarding your child’s development and will return the completed questionnaires via the online questionnaire completion system.

You also agree to receive information from Easterseals relative to the results of the screening as well as periodic information about our work.

Finally, you agree to the Notice of Privacy Practices of Easterseals, Inc. that can be found here.

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.