Overall Satisfaction

Overall Satisfaction
Very
satisfied
1. Given al the considerations, how satisfied are you with your
consumer directed support program?
Very
likely
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar
7
situation?
Neither satisfied
nor dissatisfied
Very
dissatisfied
• J 2 F A • • • •
Neither likely
nor unlikely
T
Very
unlikely
r
ujd • • • • •
Met
Expectations
3. Has the consumer directed support program met the expectations Exceeded
FaUed
Expectations
that were set for you by your case manager and county social Expectations /—___
4. What services is department? the one thing that wpuldhave the greatest impact Q on J 2 your Q satisfaction Q Q Q with Q consum
supports? f\j
CM icmM
7 ^ *v mi 1
Thinking beyond consumer directed supports to your 6Wal(quality of life, A on the falowing'pari
please indicate how much you agree or disagre with each statement. Please complete th
from the perspective of the person with a developmental disability. The person who hasfte^-^
developmental disability should b1e*dlrectly involved ^completing this survey as mbch^a^possiB
INDEPENDENCE | Mobility/Control/Privacy Agree
Strongly Somewhat Neither
•A
Disagree
Somewhat Strongly
1. I can (even if someone helps me because of my disability) get • • P
2. to I have where control I want over to my go daily schedule • Q • _ • •
3. have privacy to be alone or with people I choose _\ • /—^ • •
Only people who are supposed to know my personal
4. information have access to it..
• yd • A A
5.
I can set desired outcomes (goals) for myself U • • •
6.
I can decide about how I spend my money Q • • A
7. I can make decisions that wil afect my future • _ • A
8. I am satisfied with my curent level of independence J—t^ • LJ* • •