Dear Participants, Employees, Parents, Providers and Community Members:
Each year we seek your input in completing and returning this survey to us so we can plan and prepare
for services we provide in the upcoming Calendar Year. Please help by giving us your opinions
and suggestions. If you desire you may mail this survey to:
Fayette County Board of DD, 1330 Robinson Road, Washington Court House, OH 43160.
Thank you!

* 1. Who are you? (You may check more than one.)

* 2. Please check which (if any) of the following you (or your family member) are receiving from FCBDD

* 3. Please provide your satisfaction rating for the following FCBDD Services.

  Not Satisfied Satisfied Very Satisfied N/A
EI Services - Center
EI Services - Home Based
Fayette Progressive Preschool
Family Support Services (FSS)
Special Olympics
Home and Community Based Waivers
Service and Supports (SSA)
Other (Please List: ________________)

* 4. Please provide your opinion of the following statements.

  Disagree Undecided Agree Unable to Answer
Overall, FCBDD is providing quality service to the community.
FCBDD tax dollars are being spent wisely.
Parents/Family Members of FCBDD Consumers are involved and supported.
FCBDD collaborates well with other community organizations.
Generally, FCBDD meets the needs of people in our community who have developmental disabilities.
Consumers have adequate choice in services offered.
FCBDD staff treat consumers, family members and public in general with courtesy and with respect.
FCBDD staff treat consumers with courtesy and with respect.
FCBDD staff treat family members with courtesy and with respect.
FCBDD staff treat the public in general with courtesy and with respect.
FCBDD communicates well.
FCBDD communicates well with Consumers.
FCBDD communicates well with Family Members.
FCBDD communicates well with the Public in general.

* 5. Please respond to the following questions, if applicable:

* 6. If you would like more information regarding FCBDD or follow-up to questions, please indicate what
you would like, and include your name, address and phone number.