Please complete the form below to help us prepare an estimate for your La Grande Vadrouille package. We will then contact you to make an appointment
Fields marked with an asterisk (*) are required information.
Health Insurance Number (for subsidy purposes):
Senior citizen (age 65+)Referral†General public (under age 65)
Other : Referred by CSSTReferred by SAAQVeteranPrivate insurance plan
† Person with a functional limitation who has been referred by a CSSS.
Studio1 1/22 123 1/24 1/25 1/26 1/27 1/2Other
Regular housekeepingMajor cleaningOdd jobs
Once weeklyOnce every 2 weeksOnce every 4 weeksOn calll
Number of hours per visit:
3 h (4⅟2 or smaller)3.5h4h4.5h5h6h7h
ChequePreauthorized debit/Automatic withdrawalCredit card