SurveyMonkey Powered Online Survey

We value your feedback!

The purpose of this survey is to allow you to offer feedback to BGC and the individual ISC who serves you. We encourage input from persons receiving services, conservators, guardians, family members, natural supports, Direct Support Professionals, provider agency management, and therapy providers.

NOTE: If you interact with multiple ISCs from BGC, please fill out separate surveys for each ISC.

Your answers to this survey will be anonymous and will contain no personal identifying information.

Thank you for taking the time to complete this survey.

Question Title

1. Who is your ISC?

(Please type name in box below. If unsure of ISC's name, you may leave this box blank.)

Question Title

2. Which of the following best describes you?

Person receiving services

Conservator or Guardian

Family

Natural Support (friend)

Direct Support Professional

Provider Agency Management

Therapy Provider

Other

Question Title

3. The ISC prepares Amendments to the Individual Support Plan (ISP) on a timely basis

	Agree Strongly	Agree	Disagree	Disgree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disgree Strongly	Choose one: N/A

Comments (optional)

Question Title

4. The ISP Amendments accurately reflect what is agreed upon by the COS

	Agree Strongly	Agree	Disgree	Disagree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disgree	Choose one: Disagree Strongly	Choose one: N/A

Comments (optional)

Question Title

5. The ISC effectively engages all relevant persons in developing the ISP

	Agree Strongly	Agree	Disagree	Disagree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disagree Strongly	Choose one: N/A

Comments (optional)

Question Title

6. The ISC provided a Draft ISP prior to the ISP meeting

	Agree Strongly	Agree	Disagree	Disagree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disagree Strongly	Choose one: N/A

Comments (optional)

Question Title

7. The ISP accurately reflects the person’s life and needs

	Agree Strongly	Agree	Disagree	Disagree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disagree Strongly	Choose one: N/A

Comments (optional)

Question Title

8. When there has a been any problem, the ISC helps to resolve the issue effectively

	Agree Strongly	Agree	Disagree	Disagree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disagree Strongly	Choose one: N/A

Comments (optional)

Question Title

9. The ISC works with the COS to seek a balance between what is “Important To” the person served and what is “Important For” the person served

	Agree Strongly	Agree	Disagree	Disagree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disagree Strongly	Choose one: N/A

Comments (optional)

Question Title

10. Overall, I am satisfied with the service provided by the ISC

	Agree Strongly	Agree	Disagree	Disagree Strongly	N/A
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disagree Strongly	Choose one: N/A

Comments (optional)

Question Title

11. Overall, I am satisfied with the support and services from BGC, Inc.

	Agree Strongly	Agree	Disagree	Disagree Strongly
Choose one:	Choose one: Agree Strongly	Choose one: Agree	Choose one: Disagree	Choose one: Disagree Strongly

Comments (optional)

ISC Satisfaction Survey

Question Title

1. Who is your ISC?

(Please type name in box below. If unsure of ISC's name, you may leave this box blank.)

Question Title

2. Which of the following best describes you?

Question Title

3. The ISC prepares Amendments to the Individual Support Plan (ISP) on a timely basis

Question Title

4. The ISP Amendments accurately reflect what is agreed upon by the COS

Question Title

5. The ISC effectively engages all relevant persons in developing the ISP

Question Title

6. The ISC provided a Draft ISP prior to the ISP meeting

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7. The ISP accurately reflects the person’s life and needs

Question Title

8. When there has a been any problem, the ISC helps to resolve the issue effectively

Question Title

9. The ISC works with the COS to seek a balance between what is “Important To” the person served and what is “Important For” the person served

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10. Overall, I am satisfied with the service provided by the ISC

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11. Overall, I am satisfied with the support and services from BGC, Inc.

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12. Any other comments or suggestions?

Question Title

1. Who is your ISC?(Please type name in box below. If unsure of ISC's name, you may leave this box blank.)

Question Title

2. Which of the following best describes you?

Question Title

3. The ISC prepares Amendments to the Individual Support Plan (ISP) on a timely basis

Question Title

4. The ISP Amendments accurately reflect what is agreed upon by the COS

Question Title

5. The ISC effectively engages all relevant persons in developing the ISP

Question Title

6. The ISC provided a Draft ISP prior to the ISP meeting

Question Title

7. The ISP accurately reflects the person’s life and needs

Question Title

8. When there has a been any problem, the ISC helps to resolve the issue effectively

Question Title

9. The ISC works with the COS to seek a balance between what is “Important To” the person served and what is “Important For” the person served

Question Title

10. Overall, I am satisfied with the service provided by the ISC

Question Title

11. Overall, I am satisfied with the support and services from BGC, Inc.

Question Title

12. Any other comments or suggestions?

1. Who is your ISC?

(Please type name in box below. If unsure of ISC's name, you may leave this box blank.)