Overall Satisfaction

O V E R A L L S A T I S F A C T I O N " !
Very
satisfied
Neither satisfied
nor dissatisfied
1. Given al the considerations, how satisfied are you with your
consumer directed support program?
^ • • • • • r
•
Very Neither likely
likely
nor unlikely
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
V 7
Very
dissatisfied
Very
unlikely
T
1 3 • • • • • •
Met
Expectations
3. Has the consumer directed support program met the expectations Exceeded
Failed
Expectations
. . . ., , , , . , Expectations •—
that were set for you by your case manager and county social ~n ~7J ^ ~
services department? Q L2I Q • Q Q LJ
4. What is the one thing that would have the greatest impact on your satisfaction with con
supports? - T H L * FTJFATTAOFFI KQllfiJmtAA Q /Vl ffifr \H\M
I J W - T K I ( ^ M M I A J I I I A \ x
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Thinking beyond consumer directed supports to your overall quality of life, on the following pages 14;,
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 mMmi
developmental disability should be directly involved incompleting this survey as much as possible, -^r
I N D E P E N D E N C E I Mobility/ Control / Privacy AGREE DISAGREE
Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get A
to where I want to go ijy A • •
2.
3.
I have control over my daily schedule • • •
• • • A
I have privacy to be alone or with people I choose
4. Only people who are supposed to know my personal
information have access to it • • • • •
5.
I can set desired outcomes (goals) for myself • • • •
6.
I can decide about how I spend my money • • • •
7.
8.
• I can make decisions that wil afect my future
. • I am satisfied with my curent level of independence
A
•
A
•
•
A
F
•