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For Patients

Ages and Stages Questionnaire

ASQ-Online Ages and Stages Questionnaire - Please complete prior to 9 month, 18 month and 2 year old PE's.

Because your child’s first 5 years of life are so important, we want to help you provide the best start for your child. We invite you to participate in the Ages & Stages Questionnaires, Third Edition (ASQ-3), to help you keep track of your child’s development. The questionnaire will be completed at the 9 month, 18 month and 2 year developmental physical exams.

You will be asked to answer 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.

We would like you to complete this screening just prior (within 3 days) to your child’s scheduled 9 month, 18 month or 2 year appointment so that the results are available for your provider when you arrive to the office.  Doing this prior to your appointment will allow your provider more time to actually discuss any concerns you may have, rather than wait to have you complete it at the time of the visit! 

To start your child’s screening process, please visit:

Please enter your child’s birth date and the number of weeks he or she was born premature to start the screening at the URL noted above. Please note that the information you enter into this website is secure and cannot be seen or accessed by anyone other than the program employees who have invited you to participate in this screening.

We look forward to your participation in ASQ-3!  If you have any questions or encounter any problems while completing the questionnaire, please call our office and ask to speak to our Practice Administrator!