Overall Satisfaction

Overal Satisfaction
1 Given all the considerations, how satisfied are you with your
consumer directed support program?
Very
satisfied
Very
likely
T
Neither satisfied
nor dissatisfied
Neither likely
nor unlikely
T
2. How likely would you be to recommend a consumer directed —, r r
support program in your county to a friend in a similar situation? .. ^
Very
dissatisfied
T
Very
unlikely
r
3. Has the consumer directed support program met the expectations Exceeded Met
FaUed
Expectations
that were set for you by your case manager and county social Expectations —Expectations ja,^
services department? • M • • • • •
1. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports?
Thinking beyond consumer directed supports to your overall quality of life, pn^jfollowing page?
please 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
developmental disability should be directly involved in completing this survey as much as possible.
Independence 1 Mobility / Control / Privacy Agree Disagree
Strongly Somewhat Neither Somewhat Strongly
1 can (even if someone helps me because of my disability) get
Only people who are supposed to know my personal
• • • •
• o • •
• • •
• • • •
• • • •
• • • •
1 can make decisions that will affect my future • • a •
1 am satisfied with my current level of independence . _ pi • • •