NDIS Service Agreement

Client Details

Client First Name *

Client Surname Name *

Client Date Of Birth *

NDIS Number *

This Service Agreement is for the client noted above and is made with Be You Occupational Therapy Pty Ltd. The start date of this Service Agreement is the date noted below. The Client and Be You Occupational Therapy Pty Ltd acknowledge that this Service Agreement ends when either party is notified by the other in writing. 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. *

I have read and understood the above information

Date *

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

Photography & Video Consent

Be You Occupational Therapy Pty Ltd staff may take photos and/or videos to measure the progress you're making towards achieving your goals or to include in clinical documentation, such as reports . *

I consent to Be You Occupational Therapy Pty Ltd staff taking photos and/or videos for this purpose.

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

Agency and Plan Managed NDIS Participants

The hourly rate for face-to-face occupational therapy services and non-face-to-face occupational therapy services for agency and plan managed NDIS participants (including telehealth, reporting, session planning, clinical notes, travel, sourcing equipment, client-related research, emails, phone calls and team collaboration) is $193.99. We charge for all face-to-face and non-face-to-face occupational therapy services. In the event of an NDIS benchmark price change, our hourly rate may also change. You'll be provided with notice as detailed in the Service Agreement.

Self-Managed NDIS Participants

The hourly rate for face-to-face occupational therapy services and non-face-to-face occupational therapy services for self-managed NDIS participants (including telehealth, reporting, clinical note taking, session planning, travel, sourcing equipment, client-related research, emails, phone calls and team collaboration) is $230. We charge for all face-to-face and non-face-to-face occupational therapy services.

The difference in prices explained

The National Disability Insurance Agency (NDIA) has not increased benchmark prices for occupational therapy services since 2019, despite the rising costs of running a business. While we are unable to change the rates for agency and plan managed clients, we have an increased rate for self-managed clients to reflect the quality of our service provision and the costs associated with running an allied health business.

Provider travel – non labour costs’ will be charged in addition to the amounts noted above. This includes the cost of TOLLS, public transport fares and parking tickets incurred while delivering supports for you. It also includes $0.99 for every kilometre travelled while delivering supports to you.

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. • Claim or invoice for all agreed upon services we provide for you and issue statements of the claims or invoices if you request these. • Provide at least 7 days’ notice in the event of a price rise. Align our prices with the current NDIS benchmark rates. • Treat you with respect and courtesy. • Seek your consent to share information, unless permitted by relevant legislation to share without consent. *

I have read and understood that above information

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. • 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. • Be You Occupational Therapy Pty Ltd prices align with the current NDIS benchmark rates. You agree to our fees (including face-to-face services, non-face-to-face services, provider travel and non-labour related travel costs). • 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. • Be You Occupational Therapy Pty Ltd will give the National Disability Insurance Agency (NDIS) access to all accounts and records requested by them, in accordance with relevant legislation. • 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 are unable to provide face-to-face services for you if you (or anyone present during an appointment with our staff) smoke cigarettes during the appointment. This includes smoking cigarettes inside and outside of the location of the 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 face-to-face appointments with you. *

I have read and understood the above information

Payments

Be You Occupational Therapy Pty Ltd will seek payment for the provision of supports. Supports will only be provided if invoices have been paid on time. If the client has outstanding invoices, supports will be cancelled and may only resume when outstanding invoices have been paid.

SELF MANAGED - The client / client representative has chosen to self-manage the funding for NDIS supports provided under this Service Agreement. Be You Occupational Therapy Pty Ltd 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. If an invoice is paid after the invoice due date services will cease and may only resume upon full payment of outstanding invoices. Subsequent services may need to be paid in advance of the service having been provided. NDIA MANAGED - The client has nominated the NDIA to manage the funding for supports provided under this Service Agreement. After providing those supports, Be You Occupational Therapy Pty Ltd will claim payment for those supports from the NDIA. PLAN MANAGED - The client has nominated the Plan Management Provider to manage the funding for NDIS supports provided under this Service Agreement. Be You Occupational Therapy Pty Ltd will claim payment for those supports from the Plan Manager. It is the responsibility of the client / client representative to ensure their Plan Manager can pay invoices within 7 days of the invoice being issued.

Signature of Client / Client Nominee *

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Name of Client / Client Nominee *

Signed Date *

Email of Client / Client Nominee *

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