Peer Allies Encounter

Use this form to guide encounter conversation and gather information for ORR's review.








(xxx) xxx.xxxx


Select the type of living circumstances of the person receiving services.







Questions/areas that identified a rights concern-Only check if a rights concern was identified, not just a matter of dissatisfaction or discontent (recall the critical thinking part of training)


Do you get along well with your staff/service providers? Are they kind, courteous, and respectful?


Have you ever felt uncomfortable with, or obligated to do something by staff or service providers?


Do you feel like you get to make your own decisions and have plenty of options about how you live?


Do you have enough privacy and time to yourself? Is there a part of the day that you have for personal solitude or quiet retreat?


Do you feel you're getting enough help to be as successful and independent as you can be in life?


Are you doing things and going places you enjoy in your spare time? Are you making progress on the goals or outcomes you outlined in your PCP?


Are there any specific issues or concerns you want to talk about or don't know who to talk to about?


























Are you interested in becoming a Peer Rights Ally or in receiving formal Rights training yourself-Tell others about the positives of having received rights training and what being a Peer Rights Ally does for you.










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