Overall Satisfaction

TLF^ , . . ,
."7
satisuea satisfied
Neither satisfied
nor dissatisfied
V e r y
dissatisfied
dissatisfi
RVEFT ALL THE CONSIDERATIONS, HOW SATISFIED ARE YOU WITH YOUR ~~T_~ I R—
TLUMER DIRECTED SUPPORT PROGRAM? • • • • • • •
. Very Neither likely Very
LIKELY WOULD YOU BE TO RECOMMEND A CONSUMER DIRECTED
nor unlikely N O R U K E L Y
F
unlike]
SORT PROGRAM IN YOUR COUNTY TO A FRIEND IN A SIMILAR SITUATION?
• •••••
IAS THE CONSUMER DIRECTED SUPPORT PROGRAM MET THE EXPECTATIONS Exceeded Met Faaed
»_IAT WERE SET FOR YOU BY YOUR CASE MANAGER AND COUNTY SOCIAL Expectations Expectations Expectations
PERVICES DEPARTMENT? . • • • • • •
,0VHAT IS THE ONE THING THAT WOULD HAVE THE GREATEST IMPACT ON YOUR SATISFACTION WITH CONSUMER DIRECTED
I SUPPORTS? ____
JSSSS?9 BEYOND CONSUMER DIRECTED SUPPORTS TO YOUR OVERALL QUALITY OF LIFE, ON THE FOLLOWJHG PIGES^U:
IP?®!?
9 I N D
'CATE HOW MUCH YOU AGREE OR^DISAGREE WIT'H R
EACH STATEMENT. PLEASE BOMPLETE"THESELES^TS
*J|ROM THEPERSPECTLVEJOFTHE^PERSON WTTHA DEVELOPMENT^ DISABILITY. THE PERSON WHO H A S ^ ^ I ^
DEVELOPMENTAL DISABILITY SHOULD BE'DIRECTTYTNVBLVES INCOMPLETING THIS SURVEY AS MUCH AS"POSSIBIE^ T;/
Independence | Mobility/Control/Privacy AGREE DISAGREE
HFLHH_I_^_|_FLJ_fl~_H~M_J_H Strongly Somewhat Neither Somewhat Strongly Stron
1. I CAN (EVEN IF SOMEONE HELPS M E BECAUSE OF MY DISABILITY) GET
TO WHERE I WANT TO GO
2. I HAVE CONTROL OVER M Y DAILY SCHEDULE
3. I HAVE PRIVACY TO BE ALONE OR WITH PEOPLE I CHOOSE
4. ONLY PEOPLE WHO ARE SUPPOSED TO KNOW MY PERSONAL
5.
6.
INFORMATION HAVE ACCESS TO I T . . . . . . . . . .
8. I AM SATISFIED WITH M Y CURRENT LEVEL OF INDEPENDENCE
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