ABN 47 150 794 280

NDIS Service Agreement - Psychologist

1. Parties

This Service Agreement is for:

Client First Name *

Client Surname Name *

Client Date Of Birth *

NDIS Number *

a participant in the National Disability Insurance Scheme (client), and is made between Family Minded and :

Parent/Caregiver/Client Representative Name *

2. The NDIS and this Service Agreement

This Service Agreement is made for the purpose of providing supports under the clients NDIS plan.

A copy of the clients NDIS Plan or NDIS Goals must be attached to this Service Agreement. 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 client 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.
NDIS plan to be provided to Family Minded prior to the first booked session.
- If the Service Agreement is not submitted prior to the session the session may be cancelled and the appointment time allocated to another client from the waiting list.

3. Schedule of supports

Family Minded agrees to provide the client psychology assessment and therapy services .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. Additional expenses (i.e. things that are not included as part of a client NDIS supports) are the responsibility of the client / clients representative and are not included in the cost of the supports.

4. Family Minded Responsibilities

Family Minded agrees to:

review the provision of supports at least annually with the client;
once agreed, provide supports that meet the client's needs at the client's preferred times, within calendar constraints of the service;
communicate openly and honestly in a timely manner;
treat the client with courtesy and respect;
consult the client on decisions about how supports are provided;
give the client information about managing any complaints or disagreements and details of Family Minded cancellation policy;
listen to the client’s feedback and resolve problems quickly;
give the client the required notice if Family Minded needs to end this Service Agreement (see "Ending this Service Agreement" below for more information);
protect the client's privacy and confidential information;
provide supports in a manner consistent with all relevant laws, including the NDIS Act 2013 and Rules, and the Australian Consumer Law;
keep accurate records on the supports provided to the client;

5. Responsibilities of the client / client representative

The client / client representative agrees to:

inform Family Minded about how they wish the supports to be delivered to meet the client needs;
treat Family Minded workers with courtesy and respect;
talk to Family Minded if the client has any concerns about the supports being provided;
give Family Minded the required notice if the client cannot make a scheduled appointment, noting that if the notice is not provided, Family Minded's cancellation policy will apply;
give Family Minded the required notice if the client needs to end this Service Agreement (see 'Ending this Service Agreement' below for more information); and
let Family Minded know immediately if the client NDIS plan is suspended or replaced by a new NDIS plan, or the client stops being a participant in the NDIS.

6. Payments

Family Minded will seek payment for their provision of supports after the supports have been delivered.

SELF MANAGED - The client / client representative has chosen to self-manage the funding for NDIS supports provided under this Service Agreement. Family Minded will require payment on the day, unless otherwise arranged.PLAN MANAGED - The client has nominated the Plan Management Provider to manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, Family Minded will claim payment for those supports from the Plan Manager, details below. If the plan manager reports there are no funds available to make the payment the client will be required to make the payment.

** NOTE

Unpaid Invoices

You/the client are responsible for payment of all invoices, either directly, or via the plan manager. Should you accrue a debt as you ran out of funding, we will do our best to offer flexible payment solutions, however if you do not engage in, and/or adhere to payment arrangements your unpaid invoice(s) will be passed to a debt collector.

Plan Manager Provider Name

Plan Manager Email Address

Start Date

7. Changes to this Service Agreement

If changes to the supports 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 2 weeks notice. If either party seriously breaches this Service Agreement the requirement of notice will be waived.

9. Feedback, complaints and disputes

If the client wishes to give Family Minded feedback or is not happy with the provision of supports and wishes to make a complaint, the participant can talk to Katherine Hill 03 98117052 or email info@familyminded.com.au

If the client is not satisfied or does not want to talk to this person, at any time, they can make a complaint to the NDIS Commission. Complaints to the NDIS Commission can be lodged:

online at www.ndiscommission.gov.au; or
by phone on: 1800 035 544.

10. Goods and Services Tax (GST)

For the purposes of GST legislation, the Parties confirm that:

a supply of supports 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 NDIS Act, in the client's NDIS Plan currently in effect under section 37 of the NDIS Act;
the client's NDIS Plan is expected to remain in effect during the period the supports are provided; and
the client / client representative will immediately notify the provider if the client's NDIS Plan is replaced by a new plan or the client stops being a participant in the NDIS.

11. Cancellation Policy

At Family Minded we value consistent and high quality intervention. We require 24 hours notice to reschedule or cancel a session without incurring any cancellation fees. If you give us less than 24 hours (but more than 2 hours) notice a 50% cancellation fee will be charged. If you do not attend at all, or give us 2 hours notice or less, a 100% cancellation fee will be charged. Where Family Minded cancels a support due to operational reasons, the service will be rescheduled at no penalty to either party. Where multiple cancellations or no shows occur in a 2-month period, Family Minded will initiate contact with the family and their support network to establish the supports we are providing are best suited to the family dynamics and the needs of the child.

I have read & understood the cancellation policy *

12. Contact details

The Client Representative can be contacted on:

Address *

Phone *

Email Address of Client Representative *

Family Minded can be contacted via:

Name: Katherine Hill

Phone: 03 9811 7052

Email: info@familyminded.com.au

13. Schedule of supports

I/we agree to pay for treatment/ therapy sessions provided by Family Minded through claiming against the National Disability Insurance Scheme (NDIS) service plan. Working with the NDIS we have been allocated counselling or therapy funding for the service year (enter NDIS plan Start and End dates).

NDIS PLAN START DATE *

NDIS END PLAN DATE *

The Provider agrees to provide the client therapy and/or counselling services for the duration of the agreement at the scheduled rate. These include:

Psychology assessment and treatment
Clinically relevant communications including phone calls/written programs/communication with other health professionals (any task that takes more than 20 minutes will be invoiced)
Attendance at team meetings/case conferences
Preparation of or reviewing of any reports, forms or letters as required by the NDIS or requested by the client / client representative
Cancellation charges for late notice or no show appointments (up to 100% of fees as per NDIS price guide)
Travel time to off-site appointments within the NDIS price guide rules (currently 30 mins max both ways if single appointment booked in the area).
Travel non-labour costs at $1.00 per KM (*or the current price guide amount).
Non-face-to-face preparation/resource fee ( The 10 min non-client facing fee covers the time taken to prepare and pack up for sessions, prepare resources used in the sessions, the time taken to attend to emails and short phone calls regarding our client.)

Family Minded 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.

IMPORTANT: Any service fees not met by NDIS will be covered by the client / client representative.

Frequency of support *

WeeklyFortnightlyMonthly As scheduled

The funding claimed by this service over the period of this service agreement will be at the scheduled rate of $214.41 per hour (or higher pending NDIS price guide increases), and $35.73 non-facing time for session preparation, and brief follow up tasks after sessions such as email updates, brief phone calls etc...)

The total fee for an hour session is $250.14.

Hours to be allocated to Family Minded *

Total Funding to be Allocated to Family Minded *

COPY OF NDIS PLAN OR GOALS *

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All prices will be adjusted if there is any change in the NDIS price guide during the service agreement period.

1 4. Agreement signatures

The parties understand and agree to the terms and conditions of this Service Agreement.

Signature of Client Representative *

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Name of Client Representative *

Signed Date *

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