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Phone
1 800 555-0199
Email
info@residenceassistance.ca
Service area
All of Quebec
Your name *
Your phone number *
Your email address
Preferred region or city *
Approximate monthly budget
Not sure yet
Under $2,000
$2,000 to $3,500
$3,500 to $5,000
Over $5,000
Type of residence needed
Independent
Semi-independent
Daily assistance
Cognitive impairment / memory loss
Respite or convalescent stay
Not sure yet
Preferred moving timeline
Urgent (within 2 weeks)
Within 1 to 3 months
Within 3 to 6 months
Just gathering information
Preferred contact method
Phone
Email
Text message
Tell us about your loved one (optional)
I agree that my information will be used solely to assist me in my search, in accordance with the
privacy policy
(Law 25).
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