Overall Satisfaction

erall Satisfaction
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^Sfl^MB^H^M^Mli Very nor disatisfied Vcr
>
satisfied disatisfied
Q [] [] Q Q
likely Neither nor Me' unlikely likely Faued unlikely Very
T"
. , i i , • • Expectations Expectations
3i all the considerations, how satisfied are you with your JL. ' 1
3umer Dort
likely would you be to recommend a consumer directed
. program in your county to a friend in a similar situation?
Very
.
Exceded directed support program?
the consumer directed support program met the expectations
were set for you by your case manager and county social ~n ^ ^—
ices department? 12 • • • • • •
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ing beyond consumer directed supports to your overall quality Of life, on the following pages £
e indicate how much you agree or disagree with each statement. Please complete these sections/^
the perspective of the person with a developmental disability. The person who has the fal
Sopmental disability should be directly involved in completing this survey as much as possible.
dependence I Mobility /Control /Privacy Agre
can (even if someone helps me because of my disability) get
5 where 1 want to go
have control over my daily schedule. . . . •
have privacy to be alone or with people 1 choose.. •
)nly people who are supposed to know my personal
iformation have access to it •
can set desired outcomes (goals) for myself •
can decide about how 1 spend my money . •
can make decisions that will affect my future •
am satisfied with my current level of independence •
Disagre
>trongly Somewhat
• Neither
• Somewhat
• StrongI
• • •
• • •
• • •
• • •
• • •
• • •
• • •