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Ages & Stages Questionnaires (ASQ's) //

Bringing your little one in for a
well child exam?  

There are two forms that we need for all Well Child Exams.
The ASQ and the Home Safety Questionnaire.


  1. Fill out the ASQ Online.


  2. Download and print the appropriate Home Safety form below.  

3. Fax the form to us at 907-224-8501 or drop it off at the front desk before your child's appointment so your provider has plenty of time to review your responses.  


If you can't get the form to us before your appointment, please arrive 20-30 minutes early

to allow time for provider review.

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