Screening Forms

Along with the forms below, please bring a copy of your child's birth certificate and immunization records to their screening appointment.

Forms to be completed for Screening:
Health History form

Screening Enrollment Form

ISD #181 Enrollment Form

Please choose the ASQ form below appropriate for your child's age on their screening day:
ASQ for 2 yrs, 9 mo-3 yrs, 5 mo

ASQ for 3 yrs, 6 mo-4 yrs, 5 mo

ASQ for 4 yrs, 6 mos- 5 yrs, 5 mo

Forms can be emailed to our screening secretary at:

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