Overall Satisfaction

Overall Satisfaction Neither satisfied
e r
^
!f nor dissatisfied .. e
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satisfied dissatisfied
1. Given all the considerations, how satisfied are you with your I ' 1 '
1
Very Neither likely Very
2. How
consumer
likely would
directed
you
support
be to recommend
program?
a consumer directed
O
—1
LI LJ LI
1
LI LI LI
1
support program in your county to a friend in a similar situation? .. LJ LJ LJ LJ CJ LJ
likely nor unlikely unlikely
3. Has the consumer directed support program met the expectations Exceeded Met Failed
,, . r i . . Expectations Expectations Expectations
that were set for you by your case manager and county social ~H
services department? • O • • • • •
k What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? i
\ ^ i t f x . » I^KIAQA ts^fia^J-
Thinking beyond consumer directed supports to your overall quality of life, on the following pages
please indicate how much you agree or disagree -
with: eachstatement. Please complete these sections
from the perspective of the person with a developmental disability. The person who has the '
developmental disabilityshould be directly involved in completing this survey as much as possible. -_if 0
U?d£P®ndenCe I Mobility / Control / Privacy Agree Disagree
^gmi^^g^^^mJ Strongly
Somewhat Neither Somewhat Strongly
to where 1 want to go • • 3 • •
2. 1 have control over my daily schedule • • • •
3. 1 have privacy to be alone or with people 1 choose. • • • •
4. Only people who are supposed to know my personal
information have access to it
1 can set desired outcomes (goals) for myself •
• •
•
•
•
•
•
6.
7.
8.
1 can decide about how 1 spend my money
1 can make decisions that will affect my future.
1 am satisfied with my current level of independence ...
•
•
•
•
•
•
•
•
•
•
•
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