Consumer Evaluation of Independent Living Services Received

Your comments about the services you have received through ILICIL are very important to us. The information you provide will help us provide more efficient, effective services in the future.  Please take a moment to complete the survey below.  We are grateful for you taking your time to provide feedback to us.

Phone Number

First Name

Last Name

Programs you participated in or services you received

I received services

 

1. As a result of services from ILICIL (including referral to another service provider) I have been able to access transportation (this could be because I didn't have the information before I worked with ILICIL)

2.  As a result of services from ILICIL (including referral to another service provider) I have been able to access health care services (this could be because I didn't have the information before I worked with ILICIL)

3.  As a result of services from ILICIL (including referral to another service provider) I have been able to access assistive technology resulting in increased independence in at least one significant life area (this could be because I didn't have the information before I worked with the ILICIL)

4.  I have become more involved in transportation, healthcare, housing or assistive technology initiatives within my community to increase community services available to people with disabilities

5.  ILICIL staff treated me with respect

6.  ILICIL staff encouraged me to explore my options and try something new

7.  ILICIL staff helped me to set my goals

8.  ILICIL staff helped me to reach my goals

9.  ILICIL provided information / services efficiently

10. ILICIL staff let me make my own decisions

11. ILICIL staff helped me to problem solve

12. ILICIL staff assisted in advocating for my rights

13. ILICIL assisted me in contacting others who would be helpful

14. ILICIL provided adequate follow up to their service to me

15. ILICIL helped me to live independently

16. ILICIL provided me with a valuable service

17. I would recommend ILICIL to other people with disabilities

How has your situation improved?
How might we improve our services?
Other Comments: