Overall Satisfaction

Overall Satisfaction Neither satisfied
V e r
y nor dissatisfied v
satisfied
«*
dissatisfied
1. Given all the considerations, how satisfied are you with your ' ' '
consumer directed support program? LJ Cj IM' LJ LJ U LJ
Very Neither likely Very
2. How likely would you be to recommend a consumer directed ^- ^ "°nin«iy uniikeiy_
support program in your county to a friend in a similar situation? . . LJ^j3 D Q Q Q Q
3. Has the consumer directed support program met the expectations Exceeded Met Faued
that were set for you by your case manager and county social
Exp
f tatlons E x p e c a t i o n s
i
Expectations
services department? • Q JJJ Q • Q Q
4. What is the one thing that would have the greatest irppact on your satisfaction with consumer directed
supports? |A0'^ ~"T~ /, £JL 7%- ja-QcK p-f /gil^a cJgH To
h^l^r -hA**\ v/WA -^hthil. v 4,Uo lifo 4hji
ftdr ^ _
Thinking beyond consumer directedjsupports to your overall quality, of life, on the following pages «
please indicate how muchi you agreelohdisagree with each statement. Please completethese^ections
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 | Mobility/Control/Privacy AGREE DISAGREE
•••^•••^^^••^^^^•••l 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 mv dailv schedule .Cv>?\ S'tV ^7.^
3. I have privacy to be alone or with people I choose • • Q •
4. Only people who are supposed to know my personal
6.
7.
8.
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