DT2URD NDIS Service Agreement

NDIS SERVICE AGREEMENT
1. Parties
This Service Agreement is for [insert name of participant], a participant in the National Disability Insurance Scheme (participant), and is made between: *
[insert name of participant]
Participant / participant's representative (such as a family member or friend):
[insert name of participant, /and participant's representative-if involved]
AND Provider:

Fiona Helmore-Accredited Practising Dietitian (APD)-Dietitian 2UR Door-Mobile Service
This Service Agreement will commence on [day, month, year] for the period until [insert date].
Start Date:

DayMonthYear
Date
End Date:

DayMonthYear
Date
2. Summary
This Service Agreement is made for the purpose of providing therapy services under the participant's NDIS plan.

A copy of the participant's NDIS plan is attached to this Service Agreement [delete this sentence if participant chooses not to attach their plan]. The parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to:
- Support the independence and social and economic participation of people with disability, and
- Enable people with a disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.
3. Schedule of Supports

The provider agrees to provide the participant therapy services for [insert duration of services if applicable].The supports and their prices are set out in the attached Schedule of Supports. All prices are GST inclusive (if applicable) and include the cost of providing the supports.
4. Responsibilities of Dietitian 2UR Door

Dietitian 2UR Door- Fiona Helmore, agrees to:
- Review the provision of therapy services at each occasion of service with the participant
- Once agreed, provide therapy services that meet the participant's needs at the participant's preferred times
- Communicate openly and honestly in a timely manner
- Treat the participant with courtesy and respect
- Consult the participant on decisions about how treatment is provided
- Give the participant information about managing any complaints or disagreements and details of the provider's cancellation policy (if relevant)
- Listen to the participant's feedback and resolve problems quickly
- Give the participant a minimum of 48 hours' notice if the provider has to change a scheduled appointment to provide therapy services
- Give the participant the required notice if the provider needs to end the Service Agreement (see 'Ending this Service Agreement' below for more information)
- Protect the participant's privacy and confidential information
- Provide support in a manner consistent with all relevant laws, including the National Disability Insurance Scheme Act 2013 and rules, and the Australian Consumer Law; keep accurate records on the supports provided to the participant
- Issue regular invoices and statements of the therapy services delivered to the participant as per the Terms of Business for Registered Providers.
5. Responsibilities of the participant/participant's representative

The participant/participant's representative agrees to:
- Inform the provider about how they wish the therapy services to be delivered to meet the participants needs
- Treat the provider with courtesy and respect
- Talk to the provider if the participant has any concerns about the therapy services being provided
- Give the provider a minimum of 48 hours' notice if the participant cannot make a scheduled appointment; and if the notice is not provided by then, the provider's Re-schedule and cancellation policy will apply
- Give the provider the required notice if the participant needs to end the Service Agreement (see 'Ending this Service Agreement' below for more information), and
- Let the provider know immediately if the participant's NDIS plan is suspended or replaced by a new NDIS plan or the participant stops being a participant in the NDIS.
6. Payments

Dietitian 2UR Door, Fiona Helmore, will seek payment for their provision of therapy services in the following manner after the [participant / participant's representative] confirms satisfactory delivery:
Please select ONE payment option:*

The participant has chosen to self-manage the funding for NDIS services provided under this Service Agreement. After providing those services, the provider will generate an invoice on conclusion of service provision for the participant to pay. The participant can elect to pay the invoice by direct credit/cash/cheque at the time of consultation.The participant's Nominee manages the funding for services provided under this Service Agreement. After providing those services, the provider will send the participant's Nominee an invoice for those services for the participant's Nominee to pay. The participant's Nominee will pay the invoice by EFT/direct credit within 7 days.The participant has nominated the NDIA to manage the funding for services provided under this Service Agreement. After providing those services, the provider will claim payment for those supports from the NDIA.The participant has nominated the Plan Management Provider [insert name of Registered Plan Management Provider] to manage the funding for NDIS services provided under this Service Agreement. After providing those supports, the provider will claim payment for those services from: (Please fill in Name of Registered Plan Management Provider below)
Name of Registered Plan Management Provider:
7. Changes to this Service Agreement

If changes to the treatment or their delivery are required, the parties agree to discuss and review this Service Agreement. The parties agree that any changes to this Service Agreement will be in writing, signed, and dated by the parties.
8. Ending this Service Agreement

Should either party wish to end this Service Agreement they must give 1 months' notice. If either party seriously breaches this Service Agreement the requirement of notice will be waived.
9. Feedback, complaints, and disputes

If the participant wishes to give the provider feedback, the participant can talk to Fiona Helmore (Dietitian 2UR Door) on 0401133014 or dietitian2urdoor@gmail.com. If the participant is not happy with the provision of therapy services and wishes to make a complaint, the participant can talk to Fiona Helmore (as above). If the participant is not satisfied or does not want to talk to this person, the participant can contact the National Disability Insurance Agency by calling 1800 800 110, visiting one of their offices in person, or visiting www.ndis.gov.au for further information.
10.Goods and Services Tax (GST)

For the purposes of GST legislation, the Parties confirm that:
- A supply of therapy services under this Service Agreement is a supply of one or more of the reasonable and necessary supports specified in the statement included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the participant's NDIS plan currently in effect under section 37 of the NDIS Act
- The participant's NDIS plan is expected to remain in effect during the period the therapy supports are provided; and
- The [participant/participant's representative] will immediately notify the provider if the participant's NDIS Plan is replaced by a new plan or the participant stops being a participant in the NDIS.
- Dietitian 2UR Door reserves the right NOT to provide service or to cancel any future appointments for the client if you do not have sufficient funds in your plan or the plan expires. Any service fees not met by NDIS will be covered by your client / client representative.
11. Contact Details

The [participant/the participant's representative] can be contacted on:
Contact details:
Phone:

Area CodePhone Number
Mobile:
Please enter a valid mobile phone number.
Email
example@example.com
Address
Alternative contact person
The provider can be contacted on:

Contact Name:	Dietititian 2UR Door-Fiona Helmore (APD)
Mobile:	0401133014
Email:	dietitian2urdoor@gmail.com
Address:	Vermont South, VIV 3133

12. Agreement Signatures

The parties agree to the terms and conditions of this Service Agreement.
Signature of [participant/participant's representative].

Clear
Name of [participant/participant's representative]
Date

DayMonthYear
Signature of authorised person from Dietitian 2UR Door

Clear
Name of authorised person from Dietitian 2UR Door
Date

DayMonthYear
12. Copy of participant's NDIS plan

[Attach a copy of the participant's NDIS plan]
File Upload

Cancelof
13. Schedule of supports
Support-Dietetic Services & Support:
Description of Support-List the details of the supports, including scope and volume:
Price & Payment Information-List the price of the support (eg. per hour/per session/per unit) and whether NDIS funding for the support is managed by the participant, Participant's Nominee, the NDIA or a registered Plan Management Provider:
How the support will be provided-List how, when, where, and by whom the support will be provided:
14. Re-Scheduling & Cancellation Policy
Any appointment that is rescheduled two or more times consecutively will be treated as a cancellation and charged a 50% cancellation fee. A new appointment will not be rescheduled until fee is paid.

Please be advised that cancellations made up to 48 hours before a scheduled appointment will be processed without a penalty.

Cancellations made 48 hours or less before an appointment will be subject to a charge of 50% of the service rate. This includes appointments where our the dietitian is unable to access the property, is turned away, or

Cancellations made 24 hours or less before an appointment will be subject to a charge of 100% of the service rate. This includes appointments where our the dietitian is unable to access the property, is turned away, or

If for some reason Dietitian 2UR Door needs to cancel or re-schedule an appointment with less than 48 hours notice, a new appointment will be scheduled as soon as possible without penalty to the client.

Variations:

Dietitian 2UR Door-Fiona Helmore (APD) reserves the right to vary, replace or terminate this policy from time
Should be Empty:

NDIS SERVICE AGREEMENT

1. Parties

AND Provider:

2. Summary

3. Schedule of Supports

4. Responsibilities of Dietitian 2UR Door

5. Responsibilities of the participant/participant's representative

6. Payments

7. Changes to this Service Agreement

8. Ending this Service Agreement

9. Feedback, complaints, and disputes

10.Goods and Services Tax (GST)

11. Contact Details

12. Agreement Signatures

12. Copy of participant's NDIS plan

13. Schedule of supports

14. Re-Scheduling & Cancellation Policy