Overall Satisfaction

OVERALL SATISFACTION
1. Given all the considerations, how satisfied are you with your
consumer directed support program?
V 7
V e i
T
Neither satisfied
nor dissatisfied Ve
f y
satisfied
_ .,
dissatisfied
I 1 1
H Q Q • • • •
Very Neither likely Very
r u l k e
2. How likely would you be to recommend a consumer directed -^p- "° f ' y
support program in your county to a friend in a similar situation? .. ^ Q [ ] Q Q Q Q
3. Has the consumer directed support program met the expectations Exceeded Met Faded
,, , _ , , , x . - , Expectations Expectations Expectations
that were set for you by your case manager and county social ~ n ^ •
services department? ] _ _ • • • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? A . .
__ k
_y
Thinking beyond consumer directed supports to.your overall quality of life.-oh the.following pages
please indicate how much youligreeor disagree with each statement. PleasVcomplete 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 I Mobility / Control / Privacy Agree Disagree
GGGGGGM^MI^MLIM^J Strongly Somewhat Neither Somewhat Strongly
1. I can (even if someone helps me because of my disability) get
to where I want to go • • • • •
2. I have control over my daily schedule
I have privacy to be alone or with people I choose
AR
._
•
•
•
A
A
•
•
•
CO
4. Only people who are supposed to know my personal
3 A • • •
5. _ • • •
6. • A A •
7. • • • •
8. I am satisfied with my current level of independence • • A •