Overall Satisfaction

Overall 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
j
Very
dissatisfied
• jtf • • • • •
Very Neither likely Very
likely nor unlikely unlikely
• Iftti • • • •
Failed
3. Has the consumer directed support program met the expectations Exceeded Met
Expectations
r r
L . , . i c< . i . . Expectations Expectations Ex T
that were set for you by your case manager and county social
that were set for you by your case manager and county social ~n v / '
services department? • Q i LJ LJ •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? /VW^^^*>x^
Thinking beyond consur^r^ected supports to your overall quality of IH&onthe joltowmgj^ges
please indicate how much you agree~or"disagree with each statement. Please complete thejesections
from the perspective of the person with a[developmental disability., X h
?7Bife°P ^feS^S^
developmental disabilityfshould be directlyjnvblved in completing this survey as much as Pj^sjble.
Independence I Mobility / Control / Privacy Agree Disagree
: : ———I Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
3. I have privacy to be alone or with people I choose..
4. Only people who are supposed to know my personal
5. I can set desired outcomes (goals) for myself.
I can make decisions that will affect my future.
I am satisfied with my current level of indepen<
• a a •
• • • a •
• • a a
• a • 0 •
a • a •
• • a •
• a • a
• • a a
•