Get access to the special release of ASQ-3 files

ASQ^®-3 English questionnaire files are available in an alternate format designed to support customers during the COVID-19 health crisis.

Programs who have purchased ASQ-3 and are implementing screening during one-on-one virtual home visits, parent conferences, and telehealth appointments may complete this form for access to the special release files.

This alternate format may be used through June 30, 2021. The special release includes:

JPEG image files of questionnaire pages. These images can be texted or emailed to parents for screening in an interview format via interactive video conference or telephone. The images help parents see ASQ-3 items and illustrations but cannot be completed independently.
Fillable PDFs of each questionnaire’s Information Summary sheet. Providers can record screening responses, score results manually, and note follow-up action.

To access the special release files, complete the ASQ®-3 Special Release Request Form and agree to the terms of use. After submitting the form, you will receive an email with instructions for downloading the files through the Brookes Download Hub.

If you have any questions about these special release files, please contact your sales representative.

ASQ-3 SPECIAL RELEASE REQUEST FORM

First Name*
Last Name*
Your Title/Position*
Email*
Phone*
I am an authorized user of ASQ-3 English questionnaires and am signing the agreement on behalf of:
Organization Name*
Organization Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Organization Website/URL*
My organization has previously purchased ASQ-3 Questionnaires. I understand that I may be contacted to confirm this and provide a valid proof of purchase.
Confirmation*
I confirm that
- I represent an organization engaged in direct service provision to children and families.
- The organization’s employees work one-on-one with families to implement screening during interactive home visits, parent conferences, and telehealth appointments.
- The organization’s employees now need to provide these services virtually or remotely rather than in person.
- The organization is responsible for providing employees with guidance on use of the Special Release materials, virtual service delivery, and any relevant privacy considerations.
ASQ^®-3 Special Release Permission Agreement

The following paragraphs constitute the Permission Agreement (“Agreement”) for the ASQ Special Release. “Materials” refers to alternate format download files for Ages & Stages Questionnaires^®, Third Edition: A Parent-Completed Child Monitoring System (ASQ^®-3). By accessing or using the Materials, I (“the User”) am accepting the terms and conditions of this Agreement with Paul H. Brookes Publishing Co., Inc. (“Brookes Publishing Co.”).

Brookes Publishing Co. authorizes the User to: a) download the Materials to share with their organization’s employees by email or text to support interactive virtual service provision to children and families; and b) post the Materials for access on a local area network (LAN) or intranet, provided that all employees with access work at the same office as the User. The Materials may not be posted on the Internet under any circumstances.

Brookes Publishing authorizes the User and employees of the User’s organization to: a) share the Materials in JPEG format (ASQ-3 questionnaire images) directly with individual families by text or email for viewing during interactive web conferences and telephone calls as they implement ASQ-3 screening; and b) use the Materials in fillable PDF (ASQ-3 Information Summary sheets) to record screening responses, results, and follow-up actions during interactive web conferences and telephone calls.

Brookes Publishing Co. authorizes the User and employees of the User’s organization to access and use the Materials through June 30, 2021.

With the exception of this temporary permission to email and text the Materials, the User and employees of the User’s organization must abide by the ASQ-3 End User License Agreement and Photocopying Release.
Electronic Signature*
By entering your name, you are signing the form electronically and agree it is the legal equivalent of your manual signature on this agreement. By submitting this form you agree to receive email communications from ASQ and Brookes Publishing.

What ASQ Users are Saying

“What I love about the ASQ is that it allows our staff to catch delays quickly and allows us to get our clients the early intervention programs that they sometimes need. In many cases [ASQ] helps us catch children up before they start kindergarten, therefore providing children with the start that they deserve.”
Sharon Gee, Supervisor, Healthy Families Niagara