ASQ-3: 60-Month Questionnaire E/S Logo
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  • ASQ-3: Ages & Stages Questionnaires® - 60 Month Questionnaire

    57 months 0 days through 66 months 0 days
    ASQ-3: Ages & Stages Questionnaires® - 60 Month Questionnaire
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  • Child's information

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  • Person filling out questionnaire

  • On the following pages are questions about activities children may do. Your child may have already done some of the activities described here, and there may be some your child has not begun doing yet. For each item, please fill in the circle that indicates whether your child is doing the activity regularly, sometimes, or not yet.

    • Try each activity with your child before marking a response.
    • Make completing this questionnaire a game that is fun for you and your child.
    • Make sure your child is rested and fed.
    • Please return this questionnaire 24 hours prior to your appointment.
  • Communication

  • GROSS MOTOR

  • FINE MOTOR

    You may complete this on a device or print the page and bring with you to the appointment.
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  • PROBLEM SOLVING

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  • PERSONAL-SOCIAL

  • OVERALL

  • Ages & Stages Questionnaires®, Third Edition (ASQ-3TM), Squires & Bricker © 2009 Paul H. Brookes Publishing Co. All rights reserved.

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