Overall Satisfaction

Overall Satisfaction
1 Given all the considerations, how satisfied are you with your
consumer directed support program?
Very
satisfied
T
Neither satisfied
nor dissatisfied
J. I:T RAL.R V
Very
likely
Neither likely
nor unlikely
R
2. How likely would you be to recommend a consumer directed —i , ,
t
Very
dissatisfied
support program in your county to a friend in a similar situation? . . pg| Ql Q Ql CI Q Q
Very
unlikelv
3 Has the consumer directed support program met the expectations Exceeded Met
Failed
Expectations
° -
, , , . . Expectations Expectations
that were set for you by your case manager and county social ~r— "-i •
services department? M • • • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
S U P P O R T S ? A ^ K F V ^ O ; . - ^ f*\Q^1 -V^Cs-X RS, /Afr ° A < ; P G R I ^ V . < >
' « r., • 1
1
P p.
Thinking 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
from 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.
1.
(ndependenC^j Mobility
/ Control / Privacy
I can (even if someone helps me because of my disability) get
A G R E E
Strongly Somewhat Neither
DISAGREE
Somewhat Strongly
• 3 • • •
2. • p. • • •
3. • • • •
4.
5.
Only people who are supposed to know my personal
•
•
•
•
•
•
•
•
6.
7. I can make decisions that will affect my future •
•
•
•
•
•
•
•
•
•
•
•
CO
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