Overall Satisfaction

Overall Satisfaction |
1. Given all the considerations, how satisfied are you with your
consumer directed support program?
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
Very
satisfied
Very
likely
3. Has the consumer directed support program met the expectations Exceeded
Neither satisfied
nor dissatisfied
Very
dissatisfied
• • • • •
Neither likely
nor unlikely
T
Met
Expectations
Very
unlikely
Failed
Expectations
i • i Expectations
that were set for you by your case manager and county social «/ - •
services department? __ • • U LI Li LI
What is the one thing that would have the greatest impact on your satisfaction with consumer directed
ports?
v y^ '—
' M h o o i F " o n o y i K i S VT^
Thinking beyond consumer directed.supports to your overall quality of life, on the follo^g pjges.
please indicate how^much you[agree or disagree with each statement. Please completethesejections
from the perspective ofthe pejsdn^hadevelopmental disability. J h e person w ^ ^ h e
developmental disability should be directly involved in completing this survey as much as^pgssible.
I Independence Mobility/Control/Privacy Agree Disagree
• • ' . . I ' " ' ' " 1 Strongly Somewhat Neither Somewhat Strongly
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. LJ
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 Q
5. I can set desired outcomes (goals) for myself •
6. I can decide about how I spend my money Q
7. I can make decisions that will affect my future •
8. I am satisfied with my current level of independence ... •
4 • •
•
•
•
i •
•
•
i
• • •
• • •
• • a
• • a
• a •