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<strong>Overall</strong> <strong>Satisfaction</strong><br />

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Given all the considerations, how satisfied are you with your<br />

consumer directed support program?<br />

How likely would you be to recommend a consumer directed<br />

support program in your county to a friend in a similar situation?<br />

Very<br />

satisfied<br />

Very<br />

likely<br />

Has the consumer directed support program met the expectations Exceeded<br />

that were set for you by your case manager and county social<br />

Neither satisfied<br />

nor dissatisfied<br />

Neither likely<br />

nor unlikely<br />

Very<br />

dissatisfied<br />

Very<br />

unlikely<br />

• • • • • •<br />

Met Failed<br />

Expectations Expectations Expectations<br />

services department? 13 • • • • • •<br />

What is the one thing that would have the greatest impact on your satisfaction with consumer directed<br />

supports? r-foos? Yoo p~r>q QA^A<br />

Thinking beyond consumer directed supports to your overall quality of life, on the following pages<br />

please indicate how much you agree or disagree with each statement. Please complete these sections<br />

from the perspective of the person with a developmental disability. The person who has the<br />

developmental disability should be directly involved in completing this survey as much as possible.<br />

Independence I Mobility/Control/Privacy Agree Disagree<br />

Strongly Somewhat Neither Somewhat Strongly<br />

I can (even if someone helps me because of my disability) get<br />

to where I want to go<br />

I have control over my daily schedule<br />

I have privacy to be alone or with people I choose<br />

Only people who are supposed to know my personal<br />

I can decide about how I spend my money<br />

I can make decisions that will affect my future<br />

I am satisfied with my current level of independence<br />

m • • • •<br />

• • • •<br />

® • • • •<br />

• • • •<br />

• • • •<br />

® • • • •<br />

• • • •<br />

• • • • •

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