Overall Satisfaction

_ _ _ _ _ _ _ v 7
Overall Satisfaction I
:
- • • • • B Neither satisfied
B
^ ^ ^
B H H M
^ 1
H
V e f
y nor dissatisfied .
V t r
*
satisfied dissatisfied
Given all the considerations, how satisfied are you with your ' ' '
consumer directed support program? 2_ LJ LJ LI LI LI LI
Very Neither likely Very
How likely would you be to recommend a consumer directed 2fL noruniikeiy ^f^-
support program in your county to a friend in a similar situation? .. 8 Q Q Q Q Q Q
Has the consumer directed support program met the expectations Exceeded Met Failed
that were set for you by your case manager and county social
E x p t i o n s
T
services department? J_* • • • • • •
What is the one thing that would have the greatest impact on your satisfaction with copsumer directed
„.w w.io i...ny men WWUIU NAVE MT? YITJCTIESI impaci on your sansraction witn consumer directed
supports? If fy_s q'\\j/^ M I DSSGJ- 4O pvnqraYnS n^A T^^RNI/VVRS
ROULD hot KOdh CJtteruJtSZ. T UOCLS CihlJUhD t^aJCe. \^\
h/fitd up hAXJ -h/^-L- to -bauclss yvu^ U/JS S/IRHS T muMr
Qithr^Jtri +n \pi-loSt> T W hWa^\CAbJ s-toOu'n has
^nppiOYid
rhinkinq beyond consumer directed supports to your overall quality of life, on the following pages^, _
)lease indicate how much you agree or disagree witiveach statement. Please complete these sections
rom the perspective of the person with a developmental disability. iThe person
ievelopmental disability should be directly involved in completing this survey as much as possible. ;: ,j
Independence | Mobility/ Control /Privacy Agree
itroogly Somewhat Neither
Disagree
Somewhat Strooelv
1 can (even if someone helps me because of my disability) get
to where 1 want to go • _ • • •
a 1 have control over my daily schedule... _ a • •
1 have privacy to be alone or with people 1 choose • _ • • •
Only people who are supposed to know my personal
information have access to it • _ a • •
1 can set desired outcomes (goals) for myself • _ • a •
1 can decide about how 1 spend my money . _ a • • •
1 can make decisions that will affect my future • _ • • •
1 am satisfied with my current level of independence • m • • •