Ages & Stages Questionnaires (ASQ)

Patients through 60 months of age are required to complete Ages & Stages Questionnaires (ASQ-3) for their scheduled routine well-visits. Please print the age appropriate form, complete it, and bring it with you to your appointment. All scoring will be done for you at the office during your visit.

Please note that patients in 18 months and 24 months age groups will also need to complete the M-Chat questionnaire, a link to which can be found next to the corresponding ASQ-3 form.

Please keep in mind that age of premature infants 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.

Child's Age	English	Español
1 month 0 days through 2 month 30 days	2 month	2 me ses
3 months 0 days through 4 months 30 days	4 month	4 me ses
5 months 0 days through 6 months 30 days	6 month	6 m eses
7 months 0 days through 8 months 30 days	8 month	8 m eses
9 months 0 days through 10 months 30 days	9 month	9 meses
11 months 0 days through 12 months 30 days	12 month	12 month
13 months 0 days through 14 months 30 days	14 month	14 me ses
15 months 0 days through 16 months 30 days	16 month	16 m eses
17 months 0 days through 18 months 30 days	18 month + M-CHAT	18 m eses + M-CHAT
19 months 0 days through 20 months 30 days	20 month	20 m eses
21 months 0 days through 22 months 30 days	22 month	22 me ses
23 months 0 days through 25 months 15 days	24 month + M-CHAT	24 m eses + M-CHAT
25 months 16 days through 28 months 15 days	27 month	27 m eses
28 months 16 days through 31 months 15 days	30 month	30 me ses
31 months 16 days through 34 months 15 days	33 month	33 m eses
34 months 16 days through 38 months 30 days	36 month	36 m eses
39 months 0 days through 44 months 30 days	42 month	42 m eses
45 months 0 days through 50 months 30 days	48 month	48 m eses
51 months 0 days through 56 months 30 days	54 month	54 m eses
57 months 0 days through 66 months 0 days	60 month	60 me ses