Wyoming Statewide Independent Living Council

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SILC Consumer Satisfaction Survey

By completing this survey, you are letting us know your feelings about the services you received. If you would like help completing this survey, please call 1-800-643-6457 and ask for Dorothy.
Which of the following groups provided your Independent Living (IL) services?	Wyoming Independent Living Rehabilitation (WILR) Wyoming Services for Independent Living (WSIL) Brain Injury Association of Wyoming (BIAW)
Could the IL Center or program better serve your needs?	Yes   No   n/a Any comments?
Please select at least two of the following services received:	Daily Living Skills Training Daily Living Durable Medical Equipment Communication Skills Training Communication Equipment Information and Referral Services Physical Restoration Services (Were funds used for surgery, therapy, etc.) Physical Accessibility Equipment (i.e. ramp, hand rails, grab bars, etc.) Referral to Vocational Rehabilitation Self Advocacy Training (Were you taught to stand up for your own legal rights and responibilites [CAP]?) Individual and Family Counseling Peer or Faciliated Support Group Community Integration (Did you get help become involved in social, education or recreational activities within the community?) Management of Secondary Disabilities Training Secondary Disabilities Equipment Consumer Directed Care (CDC) Training/Services Transportation Achieved Access to Health Care Services Referral to Other Agencies (List all; Separate multiple items with a comma) Other Individual Services (List all; Separate multiple items with a comma) Other Training Services (List all; Separate multiple items with a comma) Other Equipment (List all; Separate multiple items with a comma) Referral to Other Agencies (List all; Separate multiple items with a comma)
Did you receive the information you requested?	YesNon/a
Was the information you received clear and understandable?	YesNon/a
Please list at least one specific way in which you were more independent than when you first contacted the IL staff:
Would you recommend your IL Center or program to a friend with a disability?	YesNon/a
Please rate your level of satisfaction with the following items:
The time it took to begin services:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
Overall satisfaction with services:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
I had a major role in planning of my services:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist was willing to listen to my ideas:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist was friendly:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist was knowledgeable:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist was able to meet or speak with me when needed:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist promptly returned my phone calls:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist referred me to other agencies and resources to better meet all of my needs:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist has the ability to take action in response to my needs:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
My specialist answered all of my questions:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
Completing the paperwork was easy:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
I would refer others for these services:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
I am aware that if I have unresolved questions/ problems, I could speak with the Director or contact CAP:	Very Satisfied Satisfied Dissatisfied Very Dissatisfied n/a
Optional Information
If you would like someone to contact you, please include your name and address. All contacts will be kept confidential unless otherwise requested.
Name:
Address: (Street, City, State, Zip)
If you need communication assistance, please call 7-1-1. If you need assistance in completing this survey, please call (307) 777-7386 and ask for Denise.