Overall Satisfaction

Overal I Satisfaction Neither satisfied
f 3
? J
satisfied
1
nor dissatisfied
V e r
y
dissatisfied
Given all the considerations, how satisfied are you with your
consumer directed support program?
E K 3 • • • • •
Very y Neither likely Very
How likely would you be to recommend a consumer directed —" oru
f kely "*f*
y
support program in your county to a friend in a similar situation? .. |T/| [] [] Q [] Q Q
Has the consumer directed support program met the expectations Exceeded y Met Failed
. . . . , , i . - i Expectations Expectations Expectations
that were set for you by your case manager and county social 1 / ^ —
services department? 5J Q 0) Q Q 0) Q
What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? nififivAJtOrt D ^ A L F V ) ^ F L
Thinking beyond consumer directed supports to your overall quality of life, on the following pages :v
please indicate how much you agree or disagree with each statement. Please complete these sections
from the perspective of the person with a developmental disability. The person who has^the^, _ i
developmental disability should be directly involved in[completing this survey as much as POSSIBLES^
Independence | Mobility / Control / Privacy A G R E E DISAGREE
1. I can (even if someone helps me because of my disability) get
Strongly Somewhat Neither Somewhat Strongly
to where I want to go • • • • GBR
2. I have control over my daily schedule Q Q Q 01
3. I have privacy to be alone or with people I choose Q Q Q
4. Only people who are supposed to know my personal
information have access to it Q QK' 01 Q Q
5. I can set desired outcomes (goals) for myself • • • •
6. I can decide about how I spend my money Q Q Q Q
7. I can make decisions that will affect my future • • • / •
8. I am satisfied with my current level of independence ... •
• A • •