• SASHA THOMPSON

  • NDIS COUNSELLING & CAPACITY BUILDING
    info@sashathompson.com.au | sashathompson.com.au | 0415 714 069

  • NDIS PARTICIPANT SERVICE AGREEMENT

  • Between Sasha Thompson (ABN 29 310 289 312) and the participant or authorised representative.

  • 1. PARTICIPANT DETAILS

  • Format: 0000000000.
  • Plan start date
     - -
    2 digit day, 2 digit month, 4 digit year
  • Plan end date
     - -
    2 digit day, 2 digit month, 4 digit year

  • 2. REPRESENTATIVE / REFERRER (IF APPLICABLE)

  • Format: 0000000000.

  • 3. BILLING DETAILS

  • Invoices are issued to the participant (self-managed) or their nominated plan manager.
  • How are the NDIS funds managed for these services?

  • 4. SUPPORTS AND FEES

  • 15_043_0128_1_3      Therapy - Counsellor - Direct Service
    15_043_0128_1_3_CA   Therapy - Counsellor - Cancellation
    15_043_0128_1_3_NF   Therapy - Counsellor - Non-Face-to-Face
    15_043_0128_1_3_PT   Therapy - Counsellor - Provider Travel
    15_043_0128_1_3_RR   Therapy - Counsellor - NDIA Requested Reports
    15_043_0128_1_3_TH   Therapy - Counsellor - Telehealth

    Supports include counselling and capacity-building activities aligned with NDIS goals.

    • Fees follow the current NDIS Pricing Arrangements and Price Limits.
    • Provider travel time: up to 30 minutes each way may be charged, where permitted.
    • Non-face-to-face: post-session notes and participant-specific research may be charged where directly related to supports and permitted under NDIS rules.
    • Travel and non-face-to-face charges are discussed and agreed in advance.

  • 5. SERVICE ARRANGEMENTS

  • Frequency, duration and location of supports will be agreed before services commence.
  • Continued on page 2 | Complete electronically or print and sign.

  • SASHA THOMPSON

  • NDIS COUNSELLING & CAPACITY BUILDING

  • info@sashathompson.com.au | sashathompson.com.au | 0415 714 069

  • NDIS PARTICIPANT SERVICE AGREEMENT

  • 6. RESPONSIBILITIES AND PRIVACY

  • Sasha Thompson will provide safe, respectful supports, keep appropriate session notes, protect confidential information and invoice in accordance with applicable NDIS rules.

    The participant / representative will provide relevant information, advise of changes and ensure billing details are accurate. Information may be shared with authorised contacts only with consent or where disclosure is required or permitted by law.

  • 7. CANCELLATIONS AND ENDING SERVICES

  • Please provide 7 days notice where possible when cancelling or rescheduling. Short-notice cancellation fees may apply only where permitted by the current NDIS Pricing Arrangements and Price Limits and the agreed service terms.

    Either party may end this agreement with 14 days written notice, or sooner by mutual agreement or where safety or serious breach requires earlier termination.

  • 8. FEEDBACK AND COMPLAINTS

  • Concerns may be raised directly with Sasha Thompson. You may also contact the NDIS Quality and Safeguards Commission: 1800 035 544 | ndiscommission.gov.au

  • 9. AGREEMENT AND CONSENT

  • Support Coordinator Declaration of Authority
    By providing my digital signature below, I confirm that I am the appointed Support Coordinator for this participant. The participant (or their legal nominee) has reviewed the terms of this Service Agreement and has granted me explicit verbal or written authority to execute this document on their behalf due to immediate accessibility or technology barriers. A copy of this fully executed agreement will be saved into the participant's files.

  • By signing, the parties confirm they have read and understood this agreement, had the opportunity to ask questions and agree to the services and terms above.
  • Date
     - -
    2 digit day, 2 digit month, 4 digit year
  • Date
     - -
    2 digit day, 2 digit month, 4 digit year

  • OPTIONAL NOTES / AGREED DETAILS

  • Sasha Thompson | PACFA Registered Counsellor | ATMS Member | ABN 29 310 289 312
    Electronic typed signatures should be used only where accepted by both parties.
  • Should be Empty: