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: 

1. Hearing and Vision Worksheet
2. Screening Registration Form
3. Child Health and Developmental History
4. Early Childhood Screening Consent
5. Early Childhood Screening Release of Information
6. Please choose the correct form below based on your child's age. 
   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

Click here to register for a screening appointment.  
        
Paper forms can be printed and brought to the appointment or emailed to lisa.simenson@myprowler.org