NDIS Service Agreement

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NDIS Service Agreement

NDIS Service Agreement

This Service Agreement is made between the Participant and the Provider – Grace Care Service. This Service Agreement can be made between the Participant and/or the Participant’s representative and Grace Care Service. The Participant’s representative can be a family member, friend, or someone close to the Participant who can manage the funding for supports.

Service Provide (Under Agreement Details)

Grace Care Service
Participant's Name*(Required)
Participant's Representative (if applicable)
DD slash MM slash YYYY
DD slash MM slash YYYY

Agreement Details

DD slash MM slash YYYY
DD slash MM slash YYYY
DD slash MM slash YYYY
Funded by:*(Required)

Planned Interventions & Finance

List of services - to add more simply click the + button*

Participant's Consent

At Grace Care Service, we are committed to protect your information and ensure they are identifiable, accurately recorded, current, confidential, easily accessible to the participant and appropriately utilised by relevant workers. The Provider requires to collect some personal information about the Participant to provide the highest quality of services and supports.

The Participant has the right to gain access to the information the Provider hold about the Participant. The Privacy & Confidentiality Policy is also available in the Participant Handbook which is provided to the participant during their initial appointment. This policy provides information on how participants may request access to their personal information.

Description of Service Rate Total
Description of Service
Rate
Total
 

20 minutes Travel/Transport fees included in rates i.e 20 minutes travel to or from one appointment to another is included.

Any appointment outside of 20 minutes travel/transport will incur fees of $0.85 a kilometre in accordance with NDIS 02_050_0108_1_1 Specialised Transport to Community Access, Appointments, School, Educational Facility, Employment, Community Access.



I am aware that Grace Care Service, as my NDIS service provider, may need to communicate information to and share documents with involved parties. This informant is for all information relevant to my NDIS plan in the year ahead and associated activities. It is not for medical or personal health information. Therefore, I give consent to Grace Care Service to communicate directly and share documents with the below parties; (please tick all applicable)

Fees and Charges

Costs

All fees comply with the NDIS price guide and may change during this Service Agreement in accordance with NDIS price guide changes. If fees do change the participant will be notified in writing.

Please refer to the NDIS Price Guide

All prices are GST inclusive (if applicable) and include the cost of providing the supports.

Payment

The participant has agreed to pay to the Provider for their services and supports on the day and after the Participant’s attendance as below.

SELF-MANAGED FUNDING:

The Participant has chosen to Self-Manage the funding for NDIS supports provided under this Service Agreement.

After providing those supports, the Provider will send the Participant an invoice for those supports.

The Participant can pay the invoice by EFT, credit card, cash or cheque within 7 days with the terms outlined in the invoice.

If the invoice remains unpaid after 2 weeks, services will cease until payment of all invoices is made.

[AND / OR]

NOMINEE MANAGED FUNDING:

The Participant’s Nominee manages the funding for supports provided under this Service Agreement.

After providing those supports, the Provider will send the Participant’s Nominee an invoice for those supports for the Participant’s Nominee to pay.

The Participant’s Nominee can pay the invoice by EFT, credit card, cash or cheque within 7 days with the terms outlined in the invoice.

If the invoice remains unpaid after 2 weeks, services will cease until payment of all invoices is made. [AND / OR]

NDIA MANAGED FUNDING:

The Participant has nominated the NDIA to manage the funding for supports provided under this Service Agreement.

After providing those supports, the Provider will claim payment for those supports from the NDIA.

[AND / OR]

REGISTERED PLAN MANAGED PROVIDER:

The Participant has nominated a Registered Plan Management Provider to manage the funding for NDIS supports provided under this Service Agreement.

After providing those supports, the Provider will claim payment for those supports from the Registered Plan Management Provider.

If the invoice remains unpaid after 2 weeks, services will cease until payment of all invoices is made.

Cancellation

CANCELLATION BY THE PARTICIPANT:

If a participant makes a short-notice cancellation, which is after 3 pm the day before the service. The provider may charge up to 100% of the agreed price for their time and travel.

A cancellation is a short notice cancellation if the participant does not show up for scheduled support within a reasonable time or is not present at the agreed place and within a reasonable time when the provider is travelling to deliver the support.

CANCELLATION BY THE PROVIDER:

Where a provider has a short notice cancellation (or no show) they can recover 90% of the fee associated with the activity, subject to the terms of the service agreement with the participant.

Cancellations are accepted by email, text or phone call.

Please refer to the NDIS Price Guide

Additional Expense

Additional expenses that are not included as part of a Participant’s NDIS supports are the responsibility of the participant and are not included in the cost of the supports. Examples include: entrance fees, parking fees.

Service Delivery Conditions

Conditions and Reasons

For example only

Condition: Two consecutive non-attendance appointments will result in verbal communication with an intent to seize services if a non-attendance occurs again.

Reason: Continuity of services cannot be achieved if consecutive non-attendance occurs.

Conditions
Reasons
 

Agreement Signatures

The Parties agree to the terms and conditions of this Service Agreement and agree to receiving the NDIS welcome pack with Handbook.

Participant or Participant's Representative (if applicable)

DD slash MM slash YYYY

Provider

Grace care service

DD slash MM slash YYYY