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2022 Personal Outcomes Survey

The Center for Family Support is committed to providing supports to individuals with disabilities and to the family members who care for them. It is our mission to provide quality services so that individuals can live the lives they want.

We are trying to find out if you like our services and if they are helping you. We will use this information to improve our programs. Your answers will be kept confidential.

Question Title

* 1. Providing your contact information is optional.

Name:

Address:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. I am:

An individual receiving services

A family member/advocate

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* 3. I receive services in:

New York

New Jersey

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* 4. The services I get from Center for Family Support include (check all that apply):

Residential

Day Program

Community Habilitation

Respite

Home Care

ISS Services

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* 5. Do you like the services you receive?

	Almost Always = 100%	Sometimes = 50%	Almost Never = 0%	N/A
Residential	Residential Almost Always = 100%	Residential Sometimes = 50%	Residential Almost Never = 0%	Residential N/A
Day Program	Day Program Almost Always = 100%	Day Program Sometimes = 50%	Day Program Almost Never = 0%	Day Program N/A
Community Habilitation	Community Habilitation Almost Always = 100%	Community Habilitation Sometimes = 50%	Community Habilitation Almost Never = 0%	Community Habilitation N/A
Respite	Respite Almost Always = 100%	Respite Sometimes = 50%	Respite Almost Never = 0%	Respite N/A
Home Care	Home Care Almost Always = 100%	Home Care Sometimes = 50%	Home Care Almost Never = 0%	Home Care N/A
ISS Services	ISS Services Almost Always = 100%	ISS Services Sometimes = 50%	ISS Services Almost Never = 0%	ISS Services N/A

Comments:

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* 6. Do you have a say in choosing the services or programs you receive?

Almost Always = 100%

Sometimes = 50%

Almost Never = 0%

Comments: