Preview. Answers typed here are not sent anywhere. A live copy of this survey has its own link from the organization running it.

Consumer Satisfaction Survey

The survey as a person taking it will see it. About 7 minutes.

What this survey is for

A survey for people who have received services from a Center for Independent Living in the past twelve months. It asks what they received, whether they were treated as the person in charge of their own goals, what changed for them, and what the center could do better. It uses one agreement scale throughout so results pool across centers and years, and it gives a SILC the consumer satisfaction results its State Plan commits to reviewing.

Who should fill this out? People who received services from a Center for Independent Living in the past 12 months. A family member or support person may help, but the answers should be the consumer's own.

All the questions are on this one page. Answer what you can and choose "Submit my answers" at the end.

  • It takes about 7 minutes.
  • You may skip any question except the first one.
  • Your answers are confidential. The center sees counts and comments, never your name, unless you choose to give it at the end.
  • Nothing you say here changes the services you receive.
  • You can stop at any time. What you have answered so far still counts.

The services you received

Which services did you receive from the center in the past 12 months?

Required. Check all that apply.

  • Answers to a question, or being pointed to another program
  • Learning to do things for yourself, like cooking, budgeting or using transit
  • Time with another person with a disability who has been there
  • Help speaking up for yourself with a landlord, agency, school or employer
  • Working with the center to change a policy, law or practice
  • Or help staying out of one
  • Moving from school to adult life
  • SSI, SSDI, Medicaid, food assistance and similar
How long have you been receiving services from the center?

How did you work with the center?

Check all that apply.

Your experience

For each statement, choose how much you agree. Choose "Does not apply" if a statement is not about something you experienced.

Staff treated me with respect.

Staff listened to what I wanted.

I set my own goals, and the center worked toward them.

I got information in a format I can use.

For example large print, braille, plain language, my language, or a format my screen reader can read.

Help was available when I needed it.

The center's office, phone line and website were accessible to me.

I know how to reach the center if I need help again.

What changed

Did the center's services help you reach what you wanted?

  • We are still working on it
What changed for you because of the center?

Check all that apply.

Overall, how satisfied are you with the center?

Would you recommend the center to another person with a disability?

In your own words

About you (optional)

These questions are optional. They help the center see whether it serves everyone in its area equally well.

What is your age?

Would you like someone from the center to contact you?

Optional. Fill this in only if you want a call or an email about something you said here. Your contact details are stored separately from your answers.