NDIS Service Agreement

Client Details

Client First Name *

Client Surname Name *

Client Date Of Birth *

NDIS Number *

Current NDIS Plan Start Date *

Current NDIS Plan End Date *

This Service Agreement is for the Client noted above and is made with Be You Occupational Therapy Pty Ltd. The start and end dates of this Service Agreement are noted below. Should either party wish to end this Service Agreement prior to the noted end date, they must give 2 weeks’ notice. The requirement of notice will be waived if either party seriously breaches this Service Agreement *

I have read, understood and agree to this.

Start Date of Agreement *

End Date of Agreement *

Consent to Share Information

I give consent for Be You Occupational Therapy Pty Ltd staff to share and receive information with the following people for the purposes of helping me achieve my therapeutic goals. I understand I will be given other opportunities to provide verbal consent for Be You Occupational Therapy Pty Ltd staff to share and receive information from people not listed above for the purposes of helping me achieve my therapeutic goals.Please include contact details for these people

Feedback & Complaints

Be You Occupational Therapy Pty Ltd strive to provide exceptional therapeutic services and we are continuously seeking ways to improve. If you have a complaint about any aspect of our services, we would value the opportunity to resolve it with you. You can lodge your complaint online: https://beyouoccupationaltherapyptyltd.snapforms.com.au/form/complaints-form. We will acknowledge receipt of your complaint within 48 business hours and we will endeavour to resolve the complaint collaboratively with you within 28 business days. You can request a copy of our Feedback and Complaints Policy and Procedure by emailing info@beyouot.com. You can also contact the NDIS Quality and Safeguard Commission via phone on 1800 035 544 or online at www.ndiscommission.gov.au. *

I have read and understood the above information

Incident Management

Be You Occupational Therapy Pty Ltd has an incident management policy and procedure, which sets out the Company’s system for identifying, assessing, managing and resolving incidents that happen in connection with providing supports or services to people with disability.

Please provide a copy to me via email

Schedule of Supports

Be You Occupational Therapy Ptd Ltd is a telehealth-based sevice. We use Zoom for most therapy sessions and assessments.

Fees & Payments

The standard fee is $240 per hour for a telehealth therapy session, which includes a 40-minute telehealth therapy session, session notes and a detailed follow-up email to support reflection, integration and continued progress between sessions. If the session extends beyond 40 minutes, additional increments of 10 minutes at a pro-rata rate of $240 per hour will be invoiced.
The standard fee for assessments is $240 per hour, charged at a pro-rata rate for the time it takes to do the assessment.
The standard fee for non-face-to-face occupational therapy services (including but not limited to: analysing assessment results, report writing, clinical letter writing, session planning, sourcing equipment/resources, client-related research, emails, phone calls, text messages and team collaboration) is $240 per hour. All non-face-to-face occupational therapy services will be invoiced in increments of 10 minutes at a pro-rata rate of $240 per hour for the time it takes to complete the services.
Plan managed NDIS participants will need to make a co-contribution to cover the cost of the hourly fee. In this case, two invoices will be sent. For example, for a standard 40-minute therapy session with notes and email, one invoice is sent to the plan manager for $193.99 and one to you for $46.01. Co-contribution fees may be waivered from time-to-time for non-face-to-face services, at the Director's discretion.
Self-managed NDIS participants will be sent one invoice for the total cost of services provided for each occasion of service delivery.
Self-managed and co-contribution invoices that are overdue will incur a $10 admin fee. This will be invoiced to you and will need to be privately funded.

Acknowledgement and agreement *

I have read, understood and agree to this.

Services Requested

Please tick relevant services you wish to receive from us. By ticking these services and signing this Service Agreement, you agree with the quoted amounts for each service. *

Occupational Therapy Intervention | requested/available hours to be noted belowReview Report (for therapy clients; required prior to the next scheduled NDIA Plan review) | 3 hoursNDIS Functional Capacity & Support Needs Assessment & Report | up to 15 hours

NDIS Funds Devoted to Services at BE YOU OCCUPATIONAL THERAPY PTY LTD

Funding release type *

FullQuarterly

FULL PLAN RELEASE ALLOCATION

If your occupational therapy funding has been released in full in your current NDIS plan, please note the dollar amount of funding you wish to allocate to occupational therapy your current plan period. If this is your first session with Kimmy and you're unsure how much funding you would like to allocate for OT with her, you're welcome to pop down the dollar amount for 2 hours for an initial session to help you decide. You can complete another service agreement at any time to update this with another funding allocation if desired. PLEASE NOTE: THIS SERVICE AGREEMENT IS NOT VALID WITHOUT AN ALLOCATED AMOUNT AND WILL NEED TO BE SUBMITTED AGAIN FOR SERVICES TO COMMENCE.

QUARTERLY PLAN RELEASE ALLOCATION

If your NDIS funding is released quaterly (every three months) in your plan, please note how much funding in dollar amounts you wish to allocate to occupational therapy for each quarter of your current plan. Please note: any unused funding in a quarter will roll over into the next quarter for use as part of this Service Agreement.

If this is your first session with Kimmy and you're unsure how much funding you would like to allocate for OT with her, you're welcome to pop down the dollar amount for 2 hours for an initial session in the first service agreement quarter to help you decide.

You're also welcome to lodge a service agreement for just one quarter if you like.

You can complete another service agreement at any time to update this with another funding allocation if desired.

PLEASE NOTE: THIS SERVICE AGREEMENT IS NOT VALID WITHOUT AN ALLOCATED AMOUNT AND WILL NEED TO BE SUBMITTED AGAIN FOR SERVICES TO COMMENCE.

Quarter 1 Funding Allocation

Commencement date of quarter 1

End date of quarter 1

Funding allocation dollar amount for quarter 1

Quarter 2 Funding Allocation

Commencement date of quarter 2

End date of quarter 2

Funding allocation dollar amount for quarter 2

Quarter 3 Funding Allocation

Commencement date of quarter 3

End date of quarter 3

Funding allocation dollar amount for quarter 3

Quarter 4 Funding Allocation

Commencement date of quarter 4

End date of quarter 4

Funding allocation dollar amount for quarter 4

Agreements

Be You Occupational Therapy Pty Ltd staff commit to:

Consult you on decisions about how we provide therapeutic supports for you.

Establish a written plan detailing the nature and price of therapeutic supports to be provided for you (this is called a ‘Schedule of Supports’).
Provide occupational therapy services according to the Schedule of Supports. We will consult you and provide you with a new Schedule of Supports if we both agree a change is required to help you achieve your funded goals.
Invoice you and/or your plan manager for all agreed upon services we provide for you.
Provide at least 7 calendar days’ notice in the event of a price rise.
Treat you with respect and courtesy.
Seek your consent to share information, unless permitted by relevant legislation to share without consent.

By signing this document, you (Client) agree too and acknowledge:

Your NDIS Plan is expected to remain in effect during the period supports are provided for you by Be You Occupational Therapy Pty Ltd. You are required to let Be You Occupational Therapy Pty Ltd staff know immediately if your NDIS Plan is no longer current and if you are still receiving services from us. Please email admin@beyouot.com for any plan-related changes.
You are responsible for the payment in full for all therapeutic services provided for you by Be You Occupational Therapy Pty Ltd staff.
You agree to ensure there are sufficient funds to pay for these supports.
You agree to our fees.
You understand that services will be paused in the event that invoices are overdue and/or unpaid.
Be You Occupational Therapy Pty Ltd has a cancellation policy in alignment with the current NDIS Price Guide. We charge 100% of the cost of a scheduled service if less than 48 clear business hours’ notice of a cancellation is provided and we cannot schedule other billable work for that appointment time. You agree to our cancellation policy.
You will work collaboratively with Be You Occupational Therapy Pty Ltd to achieve your funded goals.
You will treat Be You Occupational Therapy Pty Ltd staff with courtesy and respect.
Be You Occupational Therapy Pty Ltd staff are unable to provide services for you while you (or anyone present during an appointment with our staff) are under the influence of alcohol or illicit substances at the time of appointment. Failure to comply with this will result in the appointment being cancelled and a cancellation fee being charged.
Be You Occupational Therapy Pty Ltd staff need to be notified in advance of who will be present during appointments with you.
Be You Occupational Therapy Pty Ltd staff use AI tools to support note taking during appointments, including Heidi Health and NovoPsych Scribe.

Client Signature *

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Client Name *

Signed Date *

Client Email *

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