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NDIS Service Agreement

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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:

Client Representative Name*

Practice Name*

Date*

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 is/is not 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 Wellcare Physio

3. Schedule of supports

Wellcare Physio agrees to provide the client Physiotherapy 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. Wellcare Physio Responsibilities

Wellcare Physio 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;
• 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 Wellcare Physio cancellation policy;
• listen to the client’s feedback and resolve problems quickly;
• give the client a minimum of 24 hours notice if Wellcare Physio has to change a scheduled appointment to provide supports;
• give the client the required notice if Wellcare Physio 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; and
• will issue invoices and statements of the supports delivered to the participant as per the NDIA Terms of Business for Registered Providers as requested

5. Responsibilities of the client / client representative

The client / client representative agrees to:

• inform Wellcare Physio about how they wish the supports to be delivered to meet the client needs;
• treat Wellcare Physio workers with courtesy and respect;
• talk to Wellcare Physio if the client has any concerns about the supports being provided;
• give Wellcare Physio the required notice if the client cannot make a scheduled appointment, noting that if the notice is not provided , Wellcare Physio cancellation policy will apply;
• give Wellcare Physio the required notice if the client needs to end this Service Agreement (see 'Ending this Service Agreement' below for more information); and
• let Wellcare Physio 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

Wellcare Physio will seek payment for their provision of supports after the supports have been delivered.

Payments

SELF MANAGED - The client / client representative has chosen to self-manage the funding for NDIS supports provided under this Service Agreement. After providing those supports, Wellcare Physio will send the client / client representative an invoice for those supports for the client / client representative to pay. The client / client representative will pay the invoice by direct debit / EFT within 7 days.

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, Wellcare Physio will claim payment for those supports from

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 Wellcare Physio feedback or is not happy with the provision of supports and wishes to make a complaint, the participant can talk to Name on 0400 000 000 or email

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 Wellcare Physio, we maintain our commitment to providing consistent, high-quality care. Our updated cancellation policy is as follows:

48-Hour Cancellation Policy

To avoid a cancellation fee, please notify us at least 48 hours before your scheduled appointment. If you cancel within 48 hours of your appointment, the full session fee (100%) will be charged as a cancellation fee to your account, and payment will be due at your next visit.

No-Show Policy

If you fail to attend your scheduled appointment without prior notice, or if our therapist arrives at the designated location and you are not present, the full session fee (100%) will be charged as a cancellation fee to your account, and payment will be due at your next visit.

Multiple Cancellations

In cases of repeated cancellations or no-shows within a 12-month period, Wellcare Physio will initiate a discussion with you and your support network. This is to ensure that our services align with your family's needs and dynamics, and to explore potential adjustments to better accommodate your circumstances.

Wellcare Physio Cancellations

If Wellcare Physio needs to cancel an appointment due to operational reasons, we will reschedule the session at no additional cost to you.

For any questions or to notify us of a cancellation, please contact our clinic at (03) 4050 7755. Feel free to copy and use this text as needed!

Checkbox*

I have read & understood the cancellation policy

12. Contact details

The Client Representative can be contacted on:

Client Representative Name*

Alternative contact person*

Address*

Phone*

Email Address of Client Representative*

Wellcare Physio can be contacted on:

Email: [email protected]
Phone: (03) 4050 7755

13. Schedule of supports

I/we agree to pay for treatment/ therapy sessions provided by Wellcare Physio through claiming against the National Disability Insurance Scheme (NDIS) service plan. Working with the NDIS we have been allocated physiotherapy funding for the service year (enter service dates)

Start Service Date*

Finish Service Date

The Provider agrees to provide the client physiotherapy services for the duration of the agreement at the scheduled rate. These include

• Physiotherapy assessment and treatment
• Clinically relevant communications including phone calls/written programs/communication with other health professionals (any task that takes more than 10 minutes will be invoiced)
• Attendance at team meetings/case conferences
• Assessment and trial of equipment as required
• 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

Wellcare Physio 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. Any service fees not met by NDIS will be covered by your client / client representative.

Frequency of support*

Weekly

Fortnightly

Monthly

As scheduled

Where the support will be provided*

At Clinic

At Home

The total funding claimed by this service over the period of this service agreement will be

at the scheduled rate of

Total Funding

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

Wellcare Physio will claim funding from the following support category: CB Daily Activity if agency managed

14. Agreement signatures

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

Signature of Client Representative*

Name of Client Representative*

Signed Date*

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