Please complete the form below to help us prepare an estimate for your Plumeau chiffon et compagnie 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.
Studio 1 1/2 2 12 3 1/2 4 1/2 5 1/2 6 1/2 7 1/2 Other
None Cat Dog Other :
Regular housekeeping Major cleaning Odd jobs
Once weekly Once every 2 weeks Once every 4 weeks On calll
Number of hours per visit:
3 h (4⅟2 or smaller) 3.5h 4h 4.5h 5h 6h 7h
Cheque Preauthorized debit/Automatic withdrawal Credit card