Overall Satisfaction

Overall Satisfaction
J
V e r y
Neither satisfied
nor dissatisfied
J
V e r y
_ J
satisfied dissatisfied
Given all the considerations, how satisfied are you with your ' ^ ' _^ _ '
consumer directed support program? L_J__ LI LI U LI LI
Very Neither likely Very
How likely would you be to recommend a consumer directed ""'"f^ !^f—
support program in your county to a friend in a similar situation? .. Q Q Q Q Q []
Has the consumer directed support program met the expectations Exceeded Met FaBed
. . . . . , . . . . Expectations Expectations Expectations
that were set for you by your case manager and county social ~rr- ^
services department? j_J • LI Q L_ LI LI
^/Vhat is the one thing that would have the.greatest impact on your satisfaction with consumer, directed
supports? 4V_ c^rkJuhr 10 ^\A/\ |yr HUK daxjfjMtih) ruuLdJy dJ\Ci
rhinking beyond consumer directed supports to your overall quality of life, on the following pages~ 5
Dlease 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 r KS
developmental disability should be directly involved in completing this survey as much as possibler
^dependence | Mobility /Control /Privacy Agree Disagree
•_____•__________________! Strongly Somewhat Neither Somewhat
Stroi Strongly
a
I can (even if someone helps me because of my disability) get
to where I want to go
• •
I have control over my daily schedule • • • a
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. • • • a
I can set desired outcomes (goals) for myself a
• a &
I can decide about how I spend my money • • • •
I can make decisions that will affect my future • • • a
I am satisfied with my current level of independence • • • •