Overall Satisfaction

VERATL Satisfaction ] Very
satisfied
Neither satisfied
nor dissatisfied
Very
dissatisfied
•Given all the considerations, how satisfied are you with your • , > i
^consumer directed support program? • QF • • • • •
>w likely would you be to recommend a consumer directed
[support program in your county to a friend in a similar situation?
TOT
Very
likely
—I—
[as the consumer directed support program met the expectations Exceeds
lat were set for you by your case manager and county social Expectations
Neither likely
nor unlikely
Very
unlikely
•
R
S P A • • • •
Met
FaUed
Expectations Expectations
services ^—department? QF • • • • • •
1% •
HAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED
SUPPORTS? S RV.^RHM^^4^T ,A V^N >DA (A^JJYLAX R* NTXA
^P-4fr, , : 1>~——: n
J^g beyond consumer directed supports toyouroverall quality of life, on the following pages O U ^
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o
9?F
r
djsagr^ith each statement. Please c6mplete the^s&tio^IR^
r s e c t , v e
SSFJ^ P
o f
the pereon with a developmental disability. The person who has thei*^
vgiopmental disability should be directly involved in completing this survey asTmuch 'upossfte^ ^
SILPJR^ndenCe I Mobility/Control/Privacy Agree Disagree
— • — • Strongly Somewhat Neither Somewhat Strongly
[can (even if someone helps me because of my disability) get
'vwhere I want to go D£| Q
e control over my daily schedule Q
3 privacy to be alone or with people I choose ...... •
SIS. ' *
^ 'people who are supposed to know my personal
jobation have access to it £/jf Q
set
'IT.
desired outcomes (goals) for myself jv/TT-Q fc=R
^decide about how I spend my money Y Q
GNMATE decisions that will affect my future j£F Q
GJJG*| with my current level of independence •
•
•
•
•
•
•
•
a
• • •
JQ Q — Q
• • •
• • •
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