Annual Survey of Individual Satisfaction Name (Optional) First Last Service(s) you receive from Assisted Independence, LLC:(Required)Name of Direct Support Professional(s) (DSP) or Recreational Therapist from Assisted Independence, LLC:How satisfied are you with the hours you have scheduled with your DSP(s) or Recreational Therapist?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:Does your DSP(s) or Recreational Therapist arrive and leave on time as scheduled?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:How satisfied are you with your DSP(s) or Recreational Therapist communication?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:How satisfied are you with your DSP(s) or Recreational Therapists interaction? For example, is your DSP(s) or Recreational Therapist focused entirely on you, or distracted during your scheduled time?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:How satisfied are you with your DSP(s) or Recreational Therapists advocacy (support)?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:How satisfied are you with your DSP(s) or Recreational Therapists ethical conduct?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:How satisfied are you with your ability to choose activities when you are with your DSP(s) or Recreational Therapists?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:How satisfied are you overall with your DSP(s) or Recreational Therapist?(Required) Extremely Dissatisfied Dissatisfied Neutral Satisfied Extremely Satisfied Comments:
