All new patients through 60 months of age are required to complete Ages & Stages Questionnaire (ASQ-3). Please print and complete age appropriate forms, available below for your convenience. All scoring will be done for you at the office, at time of visit.
Please note that patients in 18 months and 24 months age groups will also need to complete M-Chat questionnaire, link to which can be found next to the corresponding ASQ-3 form.
Kindly keep in mind that age of premature babies up to 24 months counts differently. To avoid confusion, and for your convenience, please use this quick ASQ Age Calculator to ensure correct ASQ-3 questionnaire is chosen for your child’s age.
Printable Questionnaire Forms