Overall Satisfaction

Overall Satisfaction
Given all the considerations, how satisfied are you with your
consumer directed support program?
J
e
!
Neither satisfied
y
j
satisfied
R
nor dissatisfied
V e r
y
dissatisfied
• • OFA • • •
Very Neither likely Very
How likely would you be to recommend a consumer directed norunhkeiy unhkeiy_
support program in your county to a friend in a similar situation? .. [] G lj| [] Q Q Q
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 ~T ^ i — ~ *—
services department? Q Q Q Q fij • Q
What is the one thing that would have the greatest impact on your satisfaction withconsumer directed
supports? Y P ^ X > 1 J U ^ \ ^ cryt ^ a-jZfyi&V~£-
T
SS!I?i?9 beyond ronsumer; DIRECTED supports to your overall quality of life, on the following pages ~T_5
please indicate how much you agree or disagree wUffeach statement. Please COMPFETE thes^se^TIOLS
t!HP. th
© perspective of the person with a developmental disability. The person who has "THE]"- %~ -
developmental disability should be directiy involved in completing this SURVEY as MUCHTS'po^^
Independence | Mobility / Control / Privacy Agree
Disagree
E**BBSBBBSSSSSSS9BHBSBL Strongly Som Somewhat Neither Somewhat Strongly
I can (even if someone helps me because of my disability) get /
to where I want to go \.
Q Q Q • Q
I have control over my daily schedule .. Q Q j^t Q Q
I have privacy to be alone or with people I choose. Q Q O
Only people who are supposed to; know my personal
information have access to it Q Qf Q Q Q
I can set desired outcomes (goals) for myself.....
I can decide about how I spend my money Q Q Q| Q|
I am satisfied with my current level of independence ... • • ^ • •
I can make decisions that will affect my future Q Q