Overall Satisfaction

Overal Satisfaction I Neither
satisfied
.*!?, nor dissatisfied
satisfied dissatisfied
1. Given all the considerations, how satisfied are you with your ' ' '
consumer directed support program? 2_l LJ LI LI LI LJ LJ
Very Neither likely Very
2. How likely would you be to recommend a consumer directed ""'"f^
support program in your county to a friend in a similar situation? .. 0 Q Q Q Q Q []
3. Has the consumer directed support program met the expectations Exceeded Met Failed
that were set for you by your case manager and county social Expectations Expectations
services department? JjQ ••••••
4. What is the one thing that would.have the greatest impact on your satisfaction with consumer directed
supports? . >'/y/T~ J ~yy ~tf
,o L ft SO^N s * P s ^ — d
overal quality of life, T h , n k , n
b e
n d
9
perspective
y° consumer
of agreVr'disagre directed
the
supports
person
to your
witha developmental disability.
on the following
please indicate how much you witffeach statement. Please complete
as^posible."
th^sesections
*'
from the The per
developmental disability should be directly involved in completing this survey as much
Independence }
Mobility/Control/Privacv Agree
Strongly Somewhat Neither
V e r y
Disagree
Somewhat Stronelv
1. I can (even if someone helps me because of my disability) get
to where I want to go _ • • • •
CM'
CO
I have control over my daily schedule. • • • •
I have privacy to be alone or withpeople I choose _ • • a •
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 • • • a
7. I can make decisions that will affect my future • _ • a a
8. I am satisfied with my current level of independence • • a a