Overall Satisfaction

Overall Satisfaction
Given all the considerations, how satisfied are you with your
consumer directed support program?
How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation? .
Has the consumer directed support program met the expectations
that were set for you by your case manager and county social
services department?
Very
satisfied
Very
likely
T
Neither satisfied
nor dissatisfied
Neither likely
nor unlikely
J
Very
dissatisfied
Very
unlikely
£ • Q • Q • Q
Exceeded Met Failed
Expectations Expectations Expectations
fa • • • • • •
A/hat is the one thing that would have the greatest impact on your satisfaction with consumer directed
Supports? , IT Ce~J)Lt±*-{^ Sa^r^M
A r~ r
^ y;«,sv/Cv_
hinking beyond consumer directed supports to your overall quality of life, on the following pages
lease indicate how much you agree or disagree with each statement. Please complete these sections
om the perspective of the person with a developmental disability. The person who has the
evelopmental disability should be directly involved in completing this survey as much as possible.
Independence"!
Mobility / Control / Privacy
I can (even if someone helps me because of my disability) get
to where I want to go •
Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
sa • • -
I have control over my daily schedule ... Q Q _1 _)
I have privacy to be alone or with people I choose.... . . . . . . . • • a •
Only people who are supposed to know my personal
information have access to it Q • |_J Q _1
I can set desired outcomes (goals) for myself • • • ® •
I can decide about how I spend my money Q Q Q (_| 21
I am satisfied with my current level of independence ...
I can make decisions that will affect my future
• • (_r • •