ASQ-3 / 4 month questionnaire

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ASQ®-3
Ages & Stages Questionnaires

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Please fill out the form below

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Month Questionnaire

(3 months 0 days through 4 months 30 days)


Date ASQ completed:

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


• Try each activity with your baby before marking a response.
• Make completing this questionnaire a game that is fun for you and your baby.
• Make sure your baby is rested and fed.

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

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