Community Services Survey If you are completing this about someone else, please let us know your relationship with them at the end of the survey. OK Question Title * 1. I am satisfied with Community Services. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 2. I enjoy the staff who work with me. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 3. I get to do things that are important to me. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 4. I wish there were more consistency in staff for my services. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 5. I know the proper people to contact if I have questions or concerns about my services. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 6. I have a voice on places I want to go and things I want to do. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 7. Staff help me be involved in my community. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 8. I feel like staff listen and respect me. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 9. I am satisfied with my living arrangements. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 10. I am satisfied with my daily activities. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 11. I feel safe when I am with my staff person. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 12. Staff help me with being healthy in various ways including appointments, going to the gym, eating healthy, and making good choices. Strongly Agree Agree Disagree Strongly Disagree N/A Strongly Agree Agree Disagree Strongly Disagree N/A OK Question Title * 13. My three favorite things to do are: OK Question Title * 14. Person completing survey is self or other (please list relationship if other). OK DONE