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| If No, please explain:
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| Do you feel that the staff who work with you display a positive attitude toward you and your supports? |
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| If No, please explain:
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| Do you feel that you have ever experienced any type of abuse or neglect while under Paradigm's care? |
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| If Yes, explain:
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| If living in a residential home with Paradigm, how satisfied are you with the security of the home and supervision by staff members? |
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| How satisfied are you with the treatment that you are receiving at the residential home from staff members and others who live in the home? |
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| Do you feel comfortable talking with staff members about any issues and/or concerns that you may feel displeased with regarding your care? |
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Do you feel that you are receiving the appropriate amount of services to meet your needs? |
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| How satisfied are you with the amount of freedom, privacy, and personal time/space that you are allowed within the home? |
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| How satisfied are you with the house rules and policies that are being used to add structure to the home environment? |
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| Any suggestions/proposed changes?
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| When you are visited by friends and loved ones, how satisfied are you with the space and privacy provided? |
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How satisfied are you with your ability to access your personal property and finances? |
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| Do you feel that things are explained to you in a manner that you can understand? |
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| If No, please explain:
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| Do you feel that you are involved in enough activities? |
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| If No, what would you suggest?
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| Do you feel that you are safe in the environment that you live, work, or go to school? |
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| Are you satisfied with where you live? |
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| I chose Paradigm for services because of (circle any that apply): |
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| If Other, Please provide services:
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| I have been with Paradigm for: |
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| What do you like about Paradigm: |
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| If Other, Please provide reason:
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| In what way are you most satisfied with Paradigm? |
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| What area do you feel needs the most improvement at Paradigm? |
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