This agreement is made between NAPA Centre Pty Ltd and the below patient and representative parent/guardian for the purposes of providing therapeutic supports. Supports are defined as any assessment, training, therapeutic intervention, reports or equipment scripting or any other services provided to the below by NAPA Centre Pty Ltd.

The agreement commences from the listed agreement start date and will remain in effect until the listed agreement end date or until either party requires the listed party to be reviewed or terminated. NAPA may review and amend these terms and conditions at any time and in doing so, will advise the below parties of any changes. 

NAPA Centre provides a specialised intensive exercise program for adults and children with developmental, neurological, sensory, behavioural, cognitive, orthopedic and other types of disabilities. 

As one might expect, there is some element of risk involved with any physical activity, fitness, intense exercise program, and the use of all exercise equipment including, but not limited to the NeuroSuit, CME/DMI related equipment, Neuromuscular re-education (TASES), Vital Stim, vibration plate, sensory equipment and the SpiderCage. Although the risk is greatly reduced with the use of safety equipment, proper supervision & training, and skilled therapists, there still remains the risk of injury during participation in activities including but not limited to soreness, bruising, bodily injuries, muscle strain, fractures, and even death. Therefore, it is necessary to get your permission to allow your child to participate in the program provided by NAPA Centre. 

Signing this document hereby releases NAPA Centre owners, directors, employees, students & volunteers from any liability, claims, demands and causes of action, now, or in the future, resulting from soreness, bruising, bodily injuries, muscle strain, fractures, and even death, however caused, occurring during, or after your child's participation. 

By signing this Informed Consent for Participation Waiver, you hereby affirm that you have fully read the above statements and understand the inherent risks involved with participation in the programs and agree/give permission for your child to participate. 

By signing this informed consent, you also hereby affirm that you have and will provide NAPA with all relevant information in regards to the treatment of your child, and will continue to provide updated information should any circumstances change. It is important that any new information about your child is provided in a timely manner and that you comply with any requests for specific information including bone density tests, the status of their hip and/or spine or requests for medical clearance if required. 

You have been informed of risks and complications that may occur and alternatives that may be available. You acknowledge that no guarantees, or assurances have been made to you or your child concerning the results intended from the treatment. 

By signing below, I acknowledge that I have read and agree to the above Terms and Conditions and I hereby assume any and all express and implied risks associated with treatment/therapy at NAPA Centre.

I hereby authorise the NAPA Centre to use the photographs and/or videos taken of my minor child, or myself, during the therapy/exercise sessions, or any other activities or functions at NAPA Centre. The use of photos or videos by NAPA Centre may be through advertising, websites, social media, or other means of communication is strictly voluntary and will not be compensated in any way.

Authorisation: I authorise the use and disclosure of my child's name, photo/video images, and/or testimonial for marketing purposes by NAPA Centre PTY LTD and/or NAPA Center Inc. I understand that information disclosed pursuant to this authorisation may be subject to disclosure and may no longer be protected by AHPRA privacy regulations.

Revocability: I understand that I may revoke this authorisation at any time, but such revocation must be received in writing by the clinic. Revocation affects disclosure moving forward and is not retroactive.

This authorisation expires 99 years from date signed. I understand that the clinic cannot condition treatment on whether or not I sign this authorisation.

IN CASE OF EMERGENCY:

If additional medical information if required for the patient or in case of emergency, NAPA Centre will first contact the primary listed parent(s)/guardian followed by the additional contacts provided. If the parent(s)/guardian(s) cannot be reached, NAPA can contact the following contacts, whomever can be reached first. If we cannot contact any of the listed contacts, we may call an ambulance if immediate medical attention is required.

Purpose: In cases where NAPA Centre has directed not to rely on acknowledgements as a basis to use or disclose health information, this form is used to obtain a patient's consent for our use and disclosure of the patient's protected health information to carry out treatment, payment activities, and healthcare operations, as described more fully in our Privacy Policy.  

It should be noted that NAPA staff may only view, access, use and disclose personal health information when it is necessary for them to do so to carry out their work duties.  

Purpose of Consent: By signing this form, you will consent to our use and disclosure of your protected health information to carry out treatment, payment activities, and healthcare operations.    

Notice of Privacy Practices: You have the right to read our Privacy Policy before you decide whether to sign this consent. Our Policy provides a description of the uses and disclosures we may make of your protected health information, and of other important matters about your protected health information. We encourage you to read it carefully and completely before signing this consent. We reserve the right to change our privacy practices as described in our Privacy Policy. If we change our privacy practices, we will issue a revised Privacy Policy, which will contain the changes. Those changes may apply to any of your protected health information that we maintain.  

Right to Revoke: You will have the right to revoke this consent at any time by giving us written notice of your revocation. Please understand that revocation of this consent will not affect any action we took in reliance on this consent before we received your revocation, and that we may decline to treat you or to continue treating you if you revoke this consent.

By signing below, I acknowledge that I have read and agree to the above Terms and Conditions

The medical and therapy services you seek imply a financial responsibility on your part, or on your nominated Parent/Guardian. This responsibility obligates you to ensure payment in full for the services you receive. If someone else (parent, spouse, domestic partner, etc.) is financially responsible for incurred expenses, please share this policy with them, as it explains our practices regarding patient billing.

By signing below and/or by receiving allied health services from Napa Centre you agree: 

1. You are ultimately responsible for all payment obligations arising out of your treatment or care and guarantee payment for these services. 

2. Third Party Payments or NDIS Payments: If a Third Party is authorised to complete payment for incurred expenses on your behalf (eg. NDIA, Plan Manager, Charity, Trust) you agree to provide NAPA Centre with all contact information and give NAPA Centre permission to contact them for the purposes of payment. If they are unable to provide financial security or have insufficient funding to pay for your outstanding debt, financial responsibility returns to the nominated Parent/Guardian. 

3. Overdue Payments: All payments for services must be completed in line with the payment policy outlined on the following pages. Payment of any overdue account balances is due within fourteen (14) days of receipt of your tax invoice. If any balance on your account is over fourteen (14) days past due, your account will be in default and auto referred to a collection agency. The balance of any account not paid within fourteen (14) days will begin to accrue interest at the rate of 1.5% per month or the maximum allowed by applicable law, whichever is lower. NAPA reserves the right to cease the provision of ongoing services if overdue payments are not received or outstanding balances are in excess of $600. 

4. Additional Charges: Patients may incur and are responsible for the payment of additional charges at the discretion of NAPA Centre including but not limited to: (i) charges for a missed appointments as per cancellation policy; (ii) charges for phone consultations; (iii) charges for copying and distribution of patient medical records; (iv) charges for extensive forms or resource preparation or completion;  (v) any costs associated with collection of patient balances, all as allowed by law; (vii) refund processing fees; (viii) cancellation or therapy transfer charges. 

5. Non-payment of Account. Should collection proceedings or other legal action become necessary to collect an overdue account, you understand that NAPA Centre has the right to disclose to an outside collection agency or attorney all relevant personal and account information necessary to collect payment for services rendered. You are responsible for all costs of collection including, but not limited to: (i) late fees and charges and interest due as a result of such delinquency; (ii) all court costs and fees (but only to the extent allowed by law); and (iii) a collection fee to be charged under separate agreement with a third-party collections agency, either as a flat fee or computed as a percentage of the total balance due up to the maximum allowed by applicable law, and to be added to the outstanding balance due and owing at the time of the referral to the third party collection agency. You acknowledge that any such interest assessed on the account will be a late fee as a result of default or delinquency on your account and is not deemed interest as part of a credit transaction. If your account is referred to a collection agency, attorney, court, or the past due status is reported to a credit reporting agency, it may have an adverse effect on your credit history; and related portions of your account, including the fact that you received treatment at our offices, may become a matter of public record. Failure to comply with any of these policies may also result in a withdrawal of care. 

6. Minor Patients. The parent/guardian of a minor is responsible for payment of the minor’s account balance. Responsibility for payment of treatment of minor children, whose parents are divorced, rests with both parents. Any court-ordered responsibility judgment must be determined between the individuals involved, without the inclusion of Napa Centre. 

7. Authorisation to Contact. You authorise NAPA Centre personnel to communicate by mail and/or e-mail according to the information provided in your patient registration information. NAPA Centre, or any agent orservicer of your patient account, may use any information you have provided, including contact information, e-mail addresses, phone numbers, to contact you for purposes related to your account, including debt collection. You authorise NAPA Centre to use this information in any manner consistent with the information you have provided, including mail, telephone calls, e-mails, or text messages. 

8. Financial Responsibility Party. By signing as Financial Responsibility statement, you hereby guarantee the full and prompt payment to NAPA Centre of all indebtedness of Patient to NAPA Centre, whether now existing or hereafter created (the “Indebtedness”); and you further agree to pay all expenses, legal or otherwise, incurred by NAPA Centre in collecting the Indebtedness, in enforcing this guarantee, or in protecting its rights under this guarantee or under any other document evidencing or securing any of the Indebtedness. This guarantee shall be a continuing, absolute and unconditional guarantee, and shall remain in force and effect until any and all said Indebtedness shall be fully paid. There shall be no obligation on the part of NAPA Centre at any time to first exhaust its remedies against Patient, any other party, or any other rights before enforcing the obligations of Financial Responsibility Party. 

Acknowledgement 
By signing below, you acknowledge that: (i) I have been provided a copy of the Napa Centre FINANCIAL RESPONSIBILITY STATEMENT; (ii) I have read, understand, and agree to their provisions and agree to the specified terms; (iii) I agree to pay all charges due (or to become due) to Napa Centre for the Patient’s care and treatment, as required or provided pursuant to my insurance plan and/or the insurance plan of another, as applicable; (iv) benefits, if any, paid by a third-party will be credited on the Patient account; (v) regardless of my insurance status or absence of insurance coverage, I am ultimately responsible for the balance on the account for any services rendered; (vi) if I failed to make any of the payment for which I am responsible in a timely manner, I will be responsible for all costs of collecting the money owed, including court costs, collection agency fees, and attorneys’ fees (to the extent allowed by law); and (vii) failure to pay when due may subject me to late payment charges and can adversely affect my credit report. 

The following guidelines cover the way we operate our clinics. Please read through the below with the understanding that any or all of the following may apply to you in your time with us at NAPA:

• Respect - NAPA Centre is a place of wellness, health, and optimism. Appropriate behaviour and respectful language by all parties is expected in order to promote the best environment for our patients and their families.
• Attendance in the clinic – It is expected that a parent/carer remains in the NAPA clinic at all times during your child’s session. Parents/carer and other family members are welcome to attend therapy sessions; however, if this presence hinders therapeutic progress or disrupts the clinic or other children, the therapist may request they leave the immediate area. 
• Illness - Please familiarise yourself with NAPA’s sickness policy and reschedule or cancel sessions if your child is ill. We have a duty of care for all our clients and our team members and if a client/parent/carer is unwell and attends face to face we may require that a mask be worn or that the session be converted to telehealth or re-scheduled to another time.
• Assistance during a session - The safety and well-being of your child and our therapists is paramount at all times. For this reason, your therapist’s may at times require additional assistance, especially for transitions or lifts. Where possible, NAPA Centre utilises therapy aides to assist in our sessions, but in the absence of this, may require you to be present at all times to also assist.
• Use of modalities - NAPA Centre practitioners will utilise all therapeutic modalities that the patient demonstrates amenability to, including but not limited to: Therapeutic Exercise and Activities, Neuromuscular Re-education, Manual Therapies, Gait Training, Electrical Stimulation, Ice/Heat. 
• Mandatory Reporting – As allied health practitioners NAPA therapists are mandatory reporters and as such are obliged adhere to state legislated safeguarding practices designed to protect our clients.
• Expectations - NAPA Centre therapies may be physically demanding beyond what you or your child is used to, but the patient’s management and safety is always paramount. It is typical for your child to have soreness, redness, bruising, or skin irritation following some interventions, such as application of the NeuroSuit, or manual cueing during therapeutic activities; but the patient and/or parents or guardians may always discuss said interventions in order to cease or reduce the aforementioned impairments.
• Teaching Facility - NAPA Centre is a teaching facility. Physiotherapy, Occupational, and Speech Therapy students and trainees may be incorporated into the treatment schedule either with direct supervision or indirect supervision based on their competency level, however students will never direct care until they have demonstrated appropriate competency to the assigned clinical instructor.
• Change of therapist - Scheduling requirements may call for therapists to change patients if necessary or your usual therapist may be away on annual/personal leave. Wherever possible we try and give you notice of such occurrences and find appropriate cover for your child’s session and ensure that proper handovers are provided so that the patient’s goals and plan of care will not be affected.   
• Feedback - If at any time you have any feedback about the service you have received at NAPA, you can call NAPA directly, email us at feedback@napacentre.com.au or arrange a meeting with our management team. You may also provide direct feedback or complaints about NAPA directly to the NDIS via the methods outlined in our service agreement or on our website.

INTENSIVE PROGRAM

CONFIRMATION & PAYMENTS
To confirm your intensive, the following must be completed:

• If Self-Managed (or paying privately), a $1000 deposit (payable within 7 days of receipt of tax invoice) will be required to secure the participant’s place. All intensives must be fully paid 30 days in advance of the session start date OR
• If NDIA-Managed, a signed NAPA Service Agreement must be returned on behalf of the participant and a valid NDIS service booking must have been successfully made OR
• If Plan-managed, a signed NAPA Service Agreement must be returned on behalf of the participant and NAPA Centre must have received acknowledgment in writing from the plan manager that the participant has sufficient funds to cover the intensive.

Please note that NDIA or plan managed funds will not be able to be used to secure or pay for an intensive that falls outside of a participant’s current plan dates, and therefore a full deposit of $1000 will be required.

Once the above is completed, your child’s place is confirmed, meaning you have made a commitment to attend all scheduled appointments in the agreed intensive program. Your child’s full intensive schedule will be allocated specifically over the intensive period with therapy hours prepared in advance for the session. It is not possible to opt out of specific weeks or days within the scheduled intensive without being charged the full fee for sessions missed. For any illness that occurs during the session our general cancellation policy (below) will apply. 

INTENSIVE PROGRAM CHANGES & CANCELLATION

To change the date of your child’s intensive following confirmation OR change significant components of the intensive (such as treatment hours/therapy type), a $250 service fee will apply. All changes are strictly subject to availability. Requests must be in writing and received no less than 30 days prior to the intensive start date.

If you need to cancel your child’s confirmed intensive you must do so by notifying NAPA in writing. Please note the following charges apply:

• If the cancellation is advised more than 30 Days prior to the session start date: A cancellation fee of $500 will be charged - which will be taken from your deposit or charged through to your plan manager/NDIA plan.
• If the cancellation is advised within 30 days of the session start date: A cancellation fee of $1000 will be charged - which will be taken from your deposit or charged through to your plan manager/NDIA plan.

WEEKLY PROGRAM

WEEKLY PROGRAM PAYMENTS

• If Self-Managed (or paying privately), weekly therapy sessions must be fully paid on the date of treatment.
• If NDIA-Managed, a signed NAPA Service Agreement must be returned on behalf of the participant that covers the treatment dates and a NDIS claim will be made on the participant’s behalf.
• If Plan-managed, a signed NAPA Service Agreement must be returned on behalf of the participant & NAPA will email all invoices for payment to the participant’s plan manager.
• In all instances, NAPA reserves the right to cease the provision of ongoing services if outstanding balances are in excess of $600. 

WEEKLY PROGRAM CHANGES AND CANCELLATIONS

• If completing an intensive with NAPA, your child’s weekly schedule will automatically be placed on hold during this time at no cost.
• If a break in your child’s weekly program is required, NAPA can put sessions on hold for a maximum of 2-weeks, up to twice a calendar year (but not within 3 months of each other).
• If a longer break is required but you still wish to hold onto your child’s appointment times/therapist, a holding fee of 50% per session fee missed is required to keep your child's place.
• Alternatively, you can release your child’s appointment times and restart them once they are ready to resume therapy. Please note that your child will likely return to the waitlist and the same session time/day/therapist may not be available

GENERAL CANCELLATION POLICY

Here at NAPA, we value both your time and our therapists’ time. Your child’s appointment time has been allocated for your needs with therapy being prepared in advance for the session. However, we understand that sometimes you may need to cancel or reschedule appointments. We ask that if you need to cancel or reschedule, you do so 48 hours prior to the appointment, so we can best manage our team's time and our waitlist demand.

• Any cancellations within 48-hours of the appointment (or by Friday if the appointment is on Monday) is considered a short-notice cancellation and will incur the full session fee per session missed.
• The cancellation fee may be reduced by 50% of the full session fee if a medical certificate is provided within 24 hours of the missed appointment/s. Medical certificates must be in your child’s name.
• If you fail to attend any scheduled appointment (with no notice), the full session fee will be applicable regardless of the reason.
• Before cancelling an appointment, please consider other options such as converting the session to a telehealth (online session) or the creation of resources for your child. Subject to availability, rescheduling to another time may also be an option.
• Repeated cancellations, regardless of the reason, reduces our ability to achieve your child’s treatment outcomes. When a client demonstrates a pattern of poor attendance or poor follow-through of recommendations, we reserve the right to offer that appointment to someone else on our waitlist who may be better placed at that time to receive our help.
• Our cancellation policy falls within the guidelines set out by the NDIA, and is in fact, more generous that what is allowable. We thank you for your understanding and compliance with the above cancellation policy, which enables us to continue to operate in this sector.

PAYMENT OF REPORTS

• Once a requested report has been completed, you will receive a notification and invoice for the report fees. This invoice must be paid in full prior to release of the report.
• Should your child’s report require amendments, these may be charged at a later date (dependant on the amendments required).

CREDITS AND REFUNDS

• Unused Credit - If you have prepaid therapy and have remaining credit at the end of an intensive, any unused money may be transferred onto future sessions or simply held on your child’s account with no further charge (unless a cancellation fee applies as per above).
• Refunds - A refund may be requested for any unused credit at any time following the completion of an intensive. A refund fee of 3% (of the amount to be refunded) will charged to cover admin and processing fees. For example, if you have $1000 in remaining credit that you would like refunded, a refund fee of $30 will apply. Refunds may take up to 30 days to be approved and applied. Please note that NAPA is only able to return funds to the source from where it was paid.
• Being a registered NDIS Provider, NAPA is routinely audited by the NDIS. If you have had money returned to you by NAPA, that you had originally claimed or obtained from your child’s NDIS plan then we strongly suggest that you return these amounts to the NDIS to avoid action on their behalf.

PRICING AND CANCELLATION POLICY DISCLAIMER

NAPA reserves the right to update service fees, cancellation policy, and cancellation fees at any time and in line with NDIA guidelines. Fees, payment and cancellation terms will be applied as currently displayed on the website www.napacentre.com.au. As an NDIS Registered Provider, all NAPA pricing and cancellation terms are compliant with the current NDIS Pricing Arrangements and Price Limits stipulations which can be found at www.ndis.gov.au.