Community Therapy NDIS Service Agreement

Our service agreement aims to be easy to read and complete.

You may call us on 1300 031 935 or email us at admin@communitytherapy.com.au with any questions.

Parties

This Agreement is between:

Provider

and

Participant name *

Date of Birth *

NDIA Number *

Plan Date Start

Plan Date End

This Service Agreement starts on

and ends on

Does your plan have funding periods *

What are the funding periods? *

Other funding period interval? *

Statement of Supports

Allied Health Services Included In this Service Agreement

Allied Health Assistant

Exercise Physiology

Dietetics

Occupational Therapy

Physiotherapy

Speech Pathology

Would you like to allocate by hours or budget? *

Allied Health Assistant Budget per Funding Period

Allied Health Assistant Hours Available per Funding Period

Exercise Physiology Budget per Funding Period

Exercise Physiology Hours Available per Funding Period

Dietetics Budget per Funding Period

Dietetics Hours Available per Funding Period

Occupational Therapy Budget per Funding Period

Occupapational Therapy Hours Available per Funding Period

Physiotherapy Budget per Funding Period

Physiotherapy Hours Available per Funding Period

Speech Pathology Budget per Funding Period

Speech Pathology Hours Available per Funding Period

Allied Health Assistant Hours

Exercise Physiology Hours

Dietetics Hours

Occupational Therapy Hours

Physiotherapy Hours

Speech Pathology Hours

Allied Health Assistant Service Booking

Exercise Physiology Service Booking

Dietetics Service Booking

Occupational Therapy Service Booking

Physiotherapy Service Booking

Speech Pathology Service Booking

Allied Health Assistant Budget Total

Allied Health Assistant Hours Available

Exercise Physiology Budget Total

Exercise Physiology Hours Available

Dietetics Budget Total

Dietetics Hours Available

Occupational Therapy Budget Total

Occupational Therapy Hours Available

Physiotherapy Budget Total

Physiotherapy Hours Available

Speech Pathology Budget Total

Speech Pathology Hours Available

How are you managing Capacity Building Supports in your plan *

Plan Managed - What email address do we send invoices to? (A copy of your service agreement will be sent to your plan manager) *

Self Managed - What email address do we send invoices to? *

How would you like to receive a copy of your service agreement and Community Therapy NDIS consumer handbook and charter?

Email Paper

Email address to send copy to (you can email multiple email addresses by separating by commas)

Participant declined a copy of their Service Agreement and Consumer Charter and Handbook but they may request a copy at any time by contacting 1300 031 935 or admin@communitytherapy.com.au

Billing and Claiming for NDIS Services

We will invoice for the following:

All face-to-face participant contact or services
All report writing
Reading of any reports or documentation related to you
Investigating recommended services, therapy or equipment
Phone calls and emails related to you, including from you

Our invoicing occurs in 15-minute increments.

We have a debtor management policy which is viewable at https://www.communitytherapy.com.au/Debtor-Management.

Importantly, this policy notes that a participant is responsible for the payment of your invoices if you do not have available funding in your NDIS plan.

If your plan is NDIA-managed, we will claim from the NDIS Participant / Provider Portal.

If your plan is plan-managed, we will send invoices to your plan manager.

If your plan is self-managed, we will send invoices to you or your plan nominee.

Travel

Travel fees will be invoiced in line with the NDIS pricing arrangements and price limits with respect to labour and non-labour costs.

Cancellations

You must provide us with 1 full business days notice to reschedule or cancel an appointment, otherwise, 100% of the appointment fees will be charged. This includes travel if the clinician has travelled to your location and you were not home.

For example, if you have an appointment on Monday at 2pm, notice of cancellation needs to be provided prior to 9am on Friday to avoid a cancellation fee.

To cancel or change a session time, please contact your clinician or the Community Therapy Office on 1300 031 935.

Responsibilities of Service Provider

We will:

Provide the services outlined in this agreement
Issue invoices weekly
Treat you and your property with respect

Service Agreement Updates

When the NDIS Pricing Arrangements and Price Limits are updated for each financial year we will issue you with an email to vary your service agreement with at least 7 days notice. You will need to advise us if you have any concerns with the variation.

Emergency Management

In the event that there is a medical emergency or another type of emergency during our service delivery, Community Therapy clinicians will take necessary actions to safeguard you and the clinician. This can include actions such as vacating the property or calling emergency services via 000.

Pandemic & Disaster Management

In the event that a natural disaster or infectious disease prohibits our clinicians from face-to-face clinical services, we will discuss with you, or your plan nominee, continuity of support and alternative care options, such as telehealth.

Responsibilities of the Participant

You will:

Keep us up to date with any changes to your NDIS plan
Treat us and our property with respect
Advise us if other people will be present at your appointment
Allow us to complete an in-home risk assessment
Not use or be under the influence of drugs or alcohol in our presence
Not ask members of our team for their personal contact details

If your plan dates change and you do not advise us, this service agreement will remain valid.

Consent for storage, management and release of information

You consent to and authorise us to collect, use, disclose, store and handle personal information in accordance with the Privacy Act and the Health Records and Information Privacy Act to:

Collect, use, disclose and handle personal information (including photographs) about you, for the purpose of providing health services to you
Sharing this information with other people who may be able to assist you. This includes:
- the NDIA; and,
- my support coordinator; and,

Please specify Specific Health Professionals

Please specify Family Members/Carers

Please specify Others

You acknowledge that we may release information without consent to:

fulfil any legal obligations (e.g. we may be required by law to disclose personal information to law enforcement agencies, courts or regulatory bodies to meet our public health obligations)

Feedback and Complaints

Feedback, compliments and complaints can be lodged:

directly with a staff member, either verbally or by providing a completed Feedback, Compliments and Complaints Form on our website;
by email to: admin@communitytherapy.com.au; or
by phone on: 1300 031 935

Disclaimer

This Agreement is made according to the rules and the goals of the National Disability Insurance Scheme (NDIS). The participant and the service provider agree that this Agreement is in keeping with the main framework of the NDIS. The intent of this framework is to ensure the participant has more choice, the ability to achieve goals and is able to participate in the community. Under tax law, the following sentence must be included in this Agreement:

"A supply of supports under this Service Agreement is a supply of one or more reasonable and necessary supports specified in the statement of supports included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS Plan currently in effect under section 37 of the NDIS Act."

Signatures

By signing this document, I am saying that I agree with all of the information included in the Service Agreement.

Person signing

ParticipantPlan NomineeOther

Participant Name

Plan Nominee Name

Person's Name and Relationship to Participant

Date

Signature of Participant / Plan Nominee / Other

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