Overall Satisfaction

Overall Satisfaction
1. Given all the considerations, how satisfied are you with your
consumer directed support program?
2. How likely would you be to recommend a consumer directed
support program in your county to a friend in a similar situation?
Very
satisfied
Very
likely
3. Has the consumer directed support program met the expectations Exceeded
that were set for you by your case manager and county social Expectations
Neither satisfied
nor dissatisfied
Very
dissatisfied
• • • • • •
Neither likely
nor unlikelv
Very
unlikely
a • • • • • •
Met Failed
Expectations Expectations
services department? Qp • • • • • •
4. What is the one thing that would have the greatest impact on your satisfaction with consumer directed
supports? Jt HiiL^i;' , -^)VL OK) u^toM pAtnAGjn .
7.
8.
0'
Thinking beyond consumer directedjupports to your overall quality of life, ontheJolJowing pages
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 personi whohas the l. ;
developmental disability should be"directly involved in completing this survey as 7
rhuch'tis*p^sl6le^f T
::'
Independence | Mobility/Control/Privacy AGREE DISAGREE
^••^•^••••^•••^•H Strongly Somewhat Neither Somewhat Strongly
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.
3. I HAVE DRIVACV TO BE ALONE OR WITH nem
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 ..,
• El • • •
• • • •
or • • • •
El • • • •
• < •
• •
• • • •
• • • •
• 4Sf • • •