In Person Consultation Form
What to Expect at Your 15 to 30 Minute Consultation

Thank you for your interest in selecting Chrysalis Spectrum as a provider for personal assistant service. Chrysalis Spectrum is a nonmedical personal assistant service agency licensed by Texas Health and Human Services.

Chrysalis Spectrum is located 8300 Cypress Creek Parkway Ste 450, Houston, TX 77070 and serves residents throughout Greater Houston. We discuss the care needs of the person requesting the service. To help prepare for the conversation please know the following:


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Email *
Expected start date *
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Diagnosis *
Gender *
Person needing care first name *
Person needing care last name *
Person needing care date of birth *
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Height *
Weight *
Can the person walk without assistance from devices (canes, wheelchairs, lifts)? *
The care needs *
Required
The tentative schedule for care *
Please describe the tentative schedule. For example the days of the week, start and end time, or specific date you are needing service. *
Caregiver preference *
Caregiver area of expertise *
Required
Zip code of person needing care *
Chrysalis Spectrum hourly rate is between $21 to $25 per hour. Prior to the start of care there is a nonrefundable retainer fee for service.   *
Required
A copy of your responses will be emailed to the address you provided.
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