Please download these forms, complete and either print and bring to screening or email them to address below.  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 screenings: 

• Hearing and Vision Worksheet
• Screening Registration Form
• Child Health and Developmental History (3-5 years)

• Early Childhood Screening Consent
• Early Childhood Screening Release of Information

•    Please choose the ASQ form below appropriate for your child's age on their screening day:

     ASQ:SE-2 for 2 yrs, 9 mo-3 yrs, 5 mo

    ASQ:SE-2 for 3 yrs, 6 mo-4 yrs, 5 mo

     ASQ:SE-2 for 4 yrs, 6 mos- 7 yrs

• Complete Online enrollment.  

        

Paper forms can be printed and brought to the appointment or emailed to lisa.simenson@myprowler.org