|
|
|
|
|
|
|
|
|
Welcome to Montgomery Center for Independant Living. The Center encourages people with disabilities to support one another in reaching their own independent living goals. The Center also promotes equal access and disability rights through advocacy and public awareness activities.
Center for Independent Living Services and Eligibility
MCIL Values Your Feedback
Our Center wants to provide the highest possible quality services to individuals with disabilities our consumers. If you will take a few moments to provide your feedback on our Center, it will be much appreciated. Any ideas for improving the Center�s responsiveness are also welcomed. If there is a question that is not relevant to your situation, please write �N/A�. Your comments are appreciated. You may electronically submit this form to us by completing it, then click on "Submit" at the end.
1. Your disability. (optional)
2. How did you hear about us?
3. Why did you call or come in?
4. How much did your contact with MCIL increase your independence?
Not well 1
2
3
4
5
Greatly N/A
5. How would you rate the information you received from MCIL?
Not Helpful 1
2
3
4
5
Extremely Helpful N/A
6. How would you rate the services you received from MCIL?
Not Helpful 1
2
3
4
5
Extremely Helpful N/A
7. How good were we as "listeners" to you? Did we understand your needs?
Not Willing To Listen 1
2
3
4
5
Listened Carefully N/A
8. If you need further assistance, will you call us?
Not Likely 1
2
3
4
5
Very likely N/A
9. What other services would you like to see at MCIL?
10. Choose (3) from the following list that are the biggest barrier to you being more independent
I can't find or pay for the equipment/devices that I need
I don�t get enough information on how to get help
Not enough health insurance to pay for my medical needs.
Not being able to get the housing I need.
No one to advocate for me
I can�t get good transportation (bus) to go out.
Getting services is too hard
No one has taught me how to advocate/speak for myself.
I have trouble telling people what I need because I use ASL, speak another language or have trouble speaking.
I can�t get in/out of my house/apartment or use my bathroom because of stairs, narrow doors or other barriers.
When I go out I can�t get around because there are not enough ramps, curb cuts or other things.
I don�t have enough help with my personal care (PCAs/Home Health Aides).
Any other comments?"
THANK YOU FOR YOUR FEEDBACK!!!
home
|
services
|
contact / directions
|
staff / board
|
funding
|
info request
|
photos
|
newsletter
|
links
|
legislation
Copyright Montgomery Center for Independant Living � 2007 All rights reserved.