Service Agreement
This agreement is made between:
First Name
Last Name
And
Willing Services (Service Provider)
The agreement will start on:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
and will end on:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Willing Services will, as a contractor and not as an employee, provide the services described in this agreement. Prices for services to be delivered are as per the NDIS Price Guide and based on a 3-hour minimum charge rate.
Client Contact Details
Client Name
First Name
Last Name
Mobile Phone Number:
Format: (000) 000-0000.
Phone Number:
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
example@example.com
Alternative Contact Person
First Name
Last Name
Alternative Contact Phone
Format: (000) 000-0000.
Service Provider Contact Details
Contact Name:
Willie Alefaio
Mobile Phone Number:
0413 700 970
Email:
willie@willingservices.com.au
Service Provider Responsibilities and Conditions
Work with the client to provide services that meet the client's needs and goals as per their NDIS Plan
Protect the client's privacy and confidentiality.
Always treat the client with courtesy and respect
Consult the client if decisions need to be made about how the services are provided
Listen to the client's feedback and resolve problems or concerns quickly
Have insurances and necessary security checks to deliver services requested safely
Keep clear and accurate records about the services provided to the client
Issue invoices that explain what services have been provided, their cost and when payment is due
Inform the client of any changes to contact details immediately
Review the service with the client as necessary
Seek client feedback regularly to ensure NDIS goals are being met and services delivered are in line with the client's objectives.
All services will be charged as per the current NDIS Price Guide
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Service Agreement
Client's Responsibilities
Pay the amount invoiced by the Service Provider by 7 days (Self-Managed clients only)
Ensure there is sufficient funds in your NDIS Plan to cover the cost of our support services
Provide feedback to the Service Provider to ensure needs are being met
Always treat the Support Worker with courtesy and respect
Discuss problems or concerns with Service Provider to seek quick resolve
Tell the Service Provider if there is a change to your NDIS Plan that could affect delivery of services and/or payment of invoices
Tell the Service Provider if any contact details set out in this agreement change
Give the Service Provider reasonable notice of the cancellation of an instance of support (24 hours' notice). Less than 24 hours' notice will incur full shift charges.
Give the Service Provider the notice required (see below) to end this agreement
Changing this Agreement
If the Client and Service Provider want to make any changes to this agreement, they must discuss the changes and mutually agree. The written changes should be signed and dated by the Client and the Service Provider.
Ending this Agreement
If either the Client or the Service Provider want to end this agreement, both parties must give 2 weeks' notice to the other. If the Client or the Service Provider seriously breaches this agreement, the notice period will not be applied.
Agreement Signatures
The Client and the Service Provider agree to the terms set out in this agreement.
Signature of client:
Date (Client Signature):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Provider representative:
Date (Provider Representative Signature):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
If signed by a Nominee
I confirm that this agreement has been explained to the person receiving the services and that they agree to the terms and conditions as set out in this agreement.
Nominee Name:
First Name
Last Name
Signature of Nominee:
Date (Nominee Signature):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Service Provider:
Date (Service Provider Signature):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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