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Overall Satisfaction

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

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 Expectations<br />

services department?<br />

Neither satisfied<br />

nor dissatisfied<br />

Very<br />

dissatisfied<br />

• • • • • •<br />

Neither likely<br />

nor unlikely<br />

Very<br />

unlikely<br />

• •••••<br />

Met<br />

Expectations<br />

Failed<br />

Expectations<br />

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

supports? -<br />

Thinking beyond consumer directed supports to your overall quality of life,on theJoljowjng pages *i<br />

please indicate how much you aglree^rdisagrei with each statement. Please completeTthese sections<br />

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

developmental disability should b'edirectiy involved in completing this survey as much"aVpo^sibte^r^<br />

^^©P^nde^eJ Mobility / Control / Privacy Agree Disagree<br />

I have control over my daily schedule<br />

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

• ' ' • • •<br />

:<br />

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

•v f<br />

information have access to it<br />

I can set desired outcomes (goals) for myself<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 />

Strongly Somewhat Neither Somewhat Strongly<br />

t<br />

•<br />

•<br />

• •<br />

• • • a<br />

mi • • • a<br />

n • • • •<br />

jji • • • a<br />

•<br />

Hi • • •<br />

Hi • •<br />

U • • • •

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