Overall Satisfaction

^vlrall Satisfaction
1 Given all the considerations, how satisfied are you with your
consumer directed support program?
2 How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
Very
satisfied
Neither satisfied
nor dissatisfied
Very
dissatisfied
E K F _ • • • • •
Very
likely
T
Neither likely
nor unlikely
T
Very
unlikely
T
Q T J • • • • •
3 Has the consumer directed support program met the expectations Met
Failed
E » * « J « I
Expectations Expectations
, , • . . . Expectations
3 S E T IOR Y U U U Y Y U U I O A S E M C U I C I Y E I E M U U U U I U Y S U U I A I • • •
that were set for you by your case manager and county social
services department? G _ M • • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? '
X,-
(A H
H • / Q
P"hinking beyond consumer directed supports to your overall quality of life, on the following pages
please indicate how much you agree or disagree with each statement. Please complete these sections
Jrom the perspective of the person with a developmental disability. The person who has the
^developmental disability should be directly involved in completing this survey as much as possible.
JNDGPEHDGNCE I Mobility / Control / Privacy A G R E E DISAGREE
1; I can (even if someone helps me because of my disability) get
to where I want to go
2.' I have control over my daily schedule
J R - .
%. °
5.
6.
1 n a v e
n |
P
r i v a c
y
t 0 b e
alone or with people I choose.
y people who are supposed to know my personal
J
.-4 P
Strongly Somewhat Neither Somewhat Strongly
• • A
• • •
• • A
• •
I _ R
•
" • •
• •
•
•
•
•
•
•
• •
• •
•
•
•
•
•
•
A