Overall Satisfaction

Overall Satisfaction
1. Given all the considerations, how satisfied are you with your
consumer directed support program?
Neither satisfied .
V e r
y
satisfied
nor dissatisfied V
V e
. fy j
dissatisfied
Very Neither likely Very
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2. How likely would you be to recommend a consumer directed nomnhkeiy " '| ' y
support program in your county to a friend in a similar situation? .. jy [ ] [ ] [ ] [ ] Q Q
3. Has the consumer directed support program met the expectations Exceeded Met Failed
. . . , , , , r
. , Expectations Expectations Expectations
that were set for you by your case manager and county social ~T_ *
services
department? El • • • • • •
4. What is the one thing that^wputerlTavethe greatest impact on your satisfaction with consumerxjireeded
supports? ) / L W / LdMa
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Thinking beyond consumer directed supports to youroverall quality of life, on the following
please indicate how much you acjreeVr disagree with each statement. Please complete these sections
from the perspective of the person with a developmental disability. The person whohas^toe^^
developmental disability shouldbe directly involved in completing this survey as much as possible.
I Agre Independence Mobility/Control/Privacy
1. I can (even if someone helps me because of my disability) get
to where I want to go
2. I have control over my daily schedule
3. I have privacy to be alone or with people I choose
4. Only people who are supposed to know my personal
information have access to it
5. I can set desired outcomes (goals) for myself
6. I can decide about how I spend my money
7. I can make decisions that will affect my future.
8. I am satisfied with my current level of independence
Disagre
Strongly Somewhat Neither Somewhat Strongly
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