Overall Satisfaction

Overall Satisfaction |
satisfied
Neither satisfied
nor dissatisfied
e r y
dissatisfied
Given all the considerations, how satisfied are you with your
consumer directed support program? LI L* LI LI LI LI
Very Neither likely Very
How likely would you be to recommend a consumer directed -^p- noruniikeiy mihkeiy
support program in your county to a friend in a similar situation? .. Q Q Q Q Q Q Q
Has the consumer directed support program met the expectations Exceeded Met Failed
, • • . ~. i Expectations Expectations Expectations
that were set for you by your case manager and county social ~n ^
services department? • • J2 • • • •
What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? _
(c
Thinking beyond consumer directed jsupports to your overall[quality of life, on the following pages
please indicate how^much you agree or disagree with each sta^^ert. PleasexJomplete these sections
from the perspective of the person with a developmental disability. The person who has the i,
developmental disability should be directly involved in completing this survey as much as possible. ; is
Independence I Mobility / Control / Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
I can (even if someone helps me because of my disability) get
to where I want to go
I have privacy to be alone or with people I choose.
Only people who are supposed to know my personal
information have access to it
I can decide about how I spend my money ..
I can make decisions that will affect my future.
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