Center For Independent Living of Northwest Florida

Center For Independent Living Of Northwest Florida, Inc.

Consumer Survey / Needs Assessment

During the past twelve months, you requested and received services through the CIL Disability Resource Center (CILDRC).
Because your input is vital to ensure continued quality of service and to make sure we are meeting all of your needs,
please take a few moments to evaluate the staff’s performance and services you
received or are receiving from the CIL Disability Resource Center (CILDRC).
If these questions don’t totally address how you feel, please write your comments in the space provided below.

Check the letter that corresponds with your answer to each question:

1. How long have you been a consumer at the CIL Disability Resource Center?
A Less than six months	C 13 months to 24 months
B six moths to twelve months	D 25 months or more

2. Who set your independent living goals?
A I set them myself.	C The staff member set them.
B The CIL staff member and I set them together.	D I don’t know who set them.

3. Are the services you are receiving making you feel more independent?
A Yes, definitely helping.	C No, I don’t think so.
B Yes, somewhat.	D No, definitely not.

4. Did the CILDRC staff members treat you with courtesy and respect?
A Yes, definitely.	C No, I don’t think so.
B Yes, I think so.	D No, definitely not.

5. Overall, how satisfied are you with the services you are receiving from the CILDRC?
A Very satisfied.	C Mildly dissatisfied.
B Mostly satisfied.	D Very dissatisfied.

6. Check any of your current needs below.

Transportation

Social

Housing

Recreational

Employment

Educational

Skills Training

Other

Other:

Comments:

Contact Information
3600 North Pace Blvd.,
Pensacola, Florida 32505
850-595-5566 (Voice/TDD)
850-595-5560 (Fax)
1-877-245-2457 (Voice/TDD)