Overall Satisfaction

Overall Satisfaction „
Thinking beyond consumer directed supports to your overall quality of life, on the following pages
please indicate how much you agree or disagree with each statement. Please complete these sections
from the perspective of the person with a developmental disability. The person who has the
developmental disability should be directly involved in completing this survey as much as possible.
Independence | Mobility / Control / Privacy Agree
Strongly Somewhat Neither
1. I can (even if someone helps me because of my disability) get
to where I want to go a
Disagree
Somewhat Stmnplv
• • •
2. I have control over my daily schedule • • • •
3. I have privacy to be alone or with people I choose • or • • •
4. Only people who are supposed to know my personal
information have access to it... • _ • • •
5. I can set desired outcomes (goals) for myself a
Neither satisfied
nor dissatisfied
satisfied dissatisfied
1. Given all the considerations, how satisfied are you with your JLs ' '
consumer directed support program? 1 LJ LJ LI LI LI LI
• • •
6. I can decide about how I spend my money • • • •
7. I can make decisions that will affect my future • a • •
8. I am satisfied with my current level of independence • 0 • • •
V c r >
V e r y
„ J
Verj' Neither likely Very
2. How likely would you be to recommend a consumer directed " oru
f kely
support program in your county to a friend in a similar situation? .. Jg( [][][][]_ [|
3. Has the consumer directed support program met the expectations Exceeded Met Failed
. . . . , . . . . . Expectations Expectations Expectations
that were set for you by your case manager and county social -71 :— ^ —
services department? • • / ) ^ _ • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? &gf>i/Vj /viy -KEEAONN. by u^/hj tW. CJITC-'KBOP LC 5\J^K-M ,