CYW ACE-Q and User Guide
The ACE-Q and User Guide have been made available to health care professionals for the purpose of information sharing. The ACE Questionnaire (“CYW ACE-Q”) is free and is intended to be used solely for informational or educational purposes. The ACE Questionnaire (“CYW ACE-Q”) is not a validated diagnostic tool, and is not intended to be used in the diagnosis, cure, mitigation, treatment or prevention of a disease or other condition.

Please provide the following information to gain access to the CYW ACE-Q and User Guide
Contact Information
First Name *
Last Name *
Email *
Title *
License Type
Professional Affiliation
Organization *
Mailing Zip *
Mailing Country *
Type of pediatric delivery system organization. (Select as many as apply) *
Other Practice Type
Setting of pediatric care delivery system *
Number of Practitioners *
Number of patients seen per year *
Additional Information
How did you hear about CYW? *
Other Source
CYW’s goal is to learn from other providers and organizations about their use of this ACE screen and lessons learned in the screening process. By checking this box you acknowledge that CYW or a representative may reach out to you by email with a survey on your organization’s use of this tool. *
Required
License Agreement
I accept these terms and conditions *
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