Ablerr Service-agreement

Ablerr

T/A Abilia Australia

ABN: 86 531 422 306
P: 0455 162 505
W: www.ablerr.com.au
E: bookings@ablerr.com.au

Name*

First NameLast Name

Who live at: Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date Of Birth*

Date

NDIS Number*

Your NDIS number

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

This agreement starts on Date:*

Date

This agreement ends on Date:*

Date

Parent/guardian name for emergency contact*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Link/ URL of services you required at Ablerr *

Please copy and paste the URL link here

Total price *

Please copy and paste the URL link here

YesNo

What type of support you need*

List the details of the support, including scope and volume.

How long is the support*

List the price of the support (e.g. per hour / per session / per unit)

How the support will be provided*

List how, when, where, and by whom the support will be provided

Ablerr wrote this service agreement. When you see the words ‘we’ or ‘us’, it means Ablerr and our Provider Partners.

We have written this service agreement in an easy to read way.

You can ask for help to read this service agreement. A friend, family member or support person may be able to help you.

What is a service agreement?

This service agreement is about the services and supports you will get from us. It explains the supports that we will give you. At the end of this document, there is a list of:

your supports
their prices

We call this your Schedule of Supports.

There is also a copy of your NDIS plan at the end of this document.
This agreement also explains:

what you can expect from us
what we expect from you.

Responsibilities are things that:

You need to do

work cooperatively
treat Ablerr staff and providers with courtesy and respect
talk to Ablerr if I have any concerns about the supports being provided
notify Ablerr of any changes to your situation that you expect will have an impact on this Agreement
work with Ablerr to agree to find a solution
Not perform any illegal activity while Ablerr are providing a service to you
Responsible to additional expenses (i.e. things that are not included as part of a Participant’s NDIS supports), are the responsibility of the Participant
(of the Participant’s parent / carer / representative), and are not included in the cost of the supports. Examples include, entrance fees, event tickets, meals, etc.
Ablerr can be contact within business hour Monday - Friday 08.30 am – 5.00 pm, unless emergency or your family can contact us to give us note while you supported by us outside business hours

We need to do

treat you with courtesy and respect
provide the agreed upon supports that meet your needs and preferred times
communicate openly and honestly in a timely manner
operate in accordance with Abilia – NDIS conflict of Interest Policy.
consult you on decisions about how supports
are provide

You need to:

tell us and also tell the provider partner how you want to get your supports
tell us and also tell the provider partner 48 hours before if you want to cancel an appointment
tell us as soon as possible if your plan changes or end
tell us and also tell the provider partner if you need to take your support worker to attend the activities or events.

We will give you:

supports that meet your needs
supports when you want them
an invoice for your supports as soon as the support is delivered

What both of us need to do together

We both need to:

treat each other kindly and with respect
work out a plan for your supports
check how your supports are going, at least once a year
talk to each other about your supports and funding
follow NDIS laws – the National Disability Insurance Scheme Act 2013
keep the paperwork for your supports
give 1 weeks’ notice if this agreement needs to end
listen to feedback
fix problems quickly

Paying for your supports

Funding is the money to pay for your supports. Tick the box to show where your funding comes from:

Plan ManageSelf Manage

If you have a Plan Management Provider, they will pay us for your supports

Registered Plan Management Business Name

Registered Plan Management Provider Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

If you Self Managed where we send the invoice to

We send the invoice to this email address

YesNo

Support Coordinator Name

If you have support coordinator

Company Name

Phone Number

Email

example@example.com

I Agreed

Your name

First NameLast Name

Your signature

Date

If you un-able to sign and your parent or nominee is responsible for you

I accept this agreement forplese type here

Your parent, nominee or guardian’s name

First NameLast Name

Signature

Date

If your Support Coordinator take a decision for you

Your Support Co-ordinator

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

I accept this agreement for blanks

Signature

Service Agreement

and Us Ablerr and our provider partners

Emergency contact

Services I need

Executed as an Agreement

Aruna Evertsen