If you are completing this about someone else, please let us know your relationship with them at the end of the survey.  

* 1. I am satisfied with Community Services.

* 2. I enjoy the staff who work with me.

* 3. I get to do things that are important to me.  

* 4. I wish there were more consistency in staff for my services.

* 5. I know the proper people to contact if I have questions or concerns about my services.  

* 6. I have a voice on places I want to go and things I want to do.  

* 7. Staff help me be involved in my community.  

* 8. I feel like staff listen and respect me.  

* 9. I am satisfied with my living arrangements.  

* 10. I am satisfied with my daily activities.  

* 11. I feel safe when I am with my staff person.  

* 12. Staff help me with being healthy in various ways including appointments, going to the gym, eating healthy, and making good choices. 

* 13. My three favorite things to do are:

* 14. Person completing survey is self or other (please list relationship if other).