NDIS Service Agreement

"*" indicates required fields

Comments

This field is for validation purposes and should be left unchanged.

Formal agreement for the provision of supports under the National Disability Insurance Scheme (NDIS).

Welcome to Bright Minds. Thank you for choosing us to support your child and for taking the time to complete this form. This form does not need to be printed, and paper copies will not be accepted.

This Service Agreement is made for the purpose of providing supports under the Participant’s National Disability Insurance Scheme (NDIS) plan. A copy of the Participant’s NDIS plan is 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 participation of people with a 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.

Should you have any questions, please contact us at any time via our Contact page.

Participant's Name*

First Last

Participant's NDIS Number*

Participant's Date of Birth*

Participant's Primary Residential Address*

Street Address Suburb State Postcode

Parent/Guardian's Name*

Parent/Guardian's Phone Number*

Parent/Guardian's Email*

Enter Email Confirm Email

Support Coordinator and Agency Details (if applicable)

Support Coordinator's Email Address (to send invoices)*

Service Provider's Email Address*

For plan-managed clients, who manages your funds? (include name, agency, email address, and phone number)

Support Management Preference*

Schedule of Supports*

15_605_0118_1_3 Early Childhood Intervention Assessment Recommendation Therapy or Training - Teacher – $193.99

15_056_0128_1_3 Assessment, Recommendation, Therapy, or Training - Other Professional - $193.99

15_613_0128_1_3 Developmental Educator - $193.99

All prices are subject to change as per the NDIS. All prices are GST inclusive and include the costs of providing the supports.

Preferred start date of Supports/Services*

Agreement duration (months)*

Preferred method of communication for agreement changes or updates*

TERMS AND CONDITIONS

Responsibilities of the Provider
The Provider agrees to:
- Review the provision of supports at least quarterly or as otherwise determined.
- Once agreed, provide supports that meet the Participants needs at regular times agreed between the Participant and the Provider.
- Communicate openly and honestly in a timely manner.
- Treat the Participant with courtesy and respect.
- Consult the Participant on decisions about how supports are provided.
- Give the Participant information about managing any complaints or disagreements and details of the Providers cancellation policy.
- Listen to the Participants feedback and resolve problems quickly.
- Give the Participant as much notice as possible if the Provider has to change a scheduled appointment to provide supports.
- Give the Participant the required notice if the provider needs to end the Service Agreement. (See ending this Service Agreement for more information)
- Protect the Participant’s privacy and confidential information.
- Provide supports in a manner consistent with all relevant laws, including the National Disability Insurance Scheme Act 2013 and Rules and the Australian Consumer Law; keep accurate records on the supports provided to the Participant, and
- Issue regular invoices and statements of the supports delivered to the Participant.

Responsibilities of the Participant/Participant's representative
The Participant/Participant’s representative agrees to:
- Inform the Provider about how they wish the supports to be delivered to meet the Participant’s needs.
- Treat the Provider with courtesy and respect.
- Talk to the Provider if the Participant has any concerns about the supports being provided.
- Give the Provider a minimum of 48 hours notice if the Participant cannot make a scheduled appointment; and if the notice is not provided by then, the Provider’s cancellation policy will apply.
- Give the Provider the required notice if the Participant need to end the Service Agreement (see ending this Service Agreement below for more information.) and;
- Let the Provider know immediately if the Participant’s NDIS plan is suspended or replaced by new NDIS plan or the Participant stops being a Participant in the NDIS.

Travel
Travel costs will be charged for out of office appointments including: appointments in the home, at school, or any other location.
Costs of travel will be as per the following: - $1.00 per kilometer travelled as per NDIS cost code: 15_799_0128_1_3
- $0.83 per minute for staff labor for up to 30 minutes for residents who reside in Tamworth/ Mudgee as per NDIS cost code: 15_056_0128_1_3.
For residents do not reside within 15km of Tamworth/Mudgee, up to 60 minutes of travel can be charged.

Cancellation Fee
Any appointments that are cancelled within 7 days of the appointment will be deemed as a late cancellation. If less than 7 days notice is provided to reschedule, cancel, or make other changes to the appointment up to 100% of the appointment rate will be charged as per the 2025/2026 NDIS Price Guide.

Payments
The Provider will seek payment for their provision of supports on the day the supports are delivered.
If the Participant has chosen to self-manage the funding for NDIS supports provided under this service agreement:
On the same day of providing those supports, the Provider will send the Participant an invoice for the Participant to pay. The Participant will pay the invoice by direct bank transfer or electronic funds transfer within 24 hours of the scheduled appointment time.

OR

If the Participants Nominee manages the funding for supports provided under this service agreement:
On the same day of providing those supports the provider will send the Participants Nominee an invoice for the Participants nominee to pay. The Participants Nominee will pay the invoice by direct bank transfer or electronic funds transfer within 24 hours of the scheduled appointment time.

OR

If the funding for any of the supports provided under this Service Agreement are managed by a Registered Plan Management Provider: The Participant has nominated the Plan Management Provider (as above) to manage the funding for NDIS supports provided under this Service Agreement. On the same day of providing those supports, the Provider will claim payment from the Registered Plan Management Provider.

PLEASE NOTE THAT BRIGHT MINDS IS UNABLE TO ACCEPT CLIENTS WHOSE SUPPORTS ARE MANAGED BY THE NDIA.

Changes to the agreement
If changes to the supports of their delivery are required, the parties agree to discuss and view this Service Agreement. The parties agree that any changes to this Service Agreement will be in writing, signed and dated by the parties.

Ending this agreement
Should either party with to end this Service Agreement, there must be 4 weeks notice given in writing. If either party seriously breaches this service agreement, the requirement of notice will be waived.
The cost of 2 weeks services will be charged to the NDIS plan at the time of the client terminating services as per the NDIS Price Guide.

Feedback, complaints or disputes
If the Participant wishes to give the Provider feedback, the participant can talk to Kylie Macpherson by emailing to organise a meeting time: [email protected]
If the Participant is not happy with the provision of supports and wishes to make a complaint, the Participant can talk to Kylie emailing to organise a meeting time: [email protected]
If the Participant is not satisfied and does not want to talk to this person, the Participant can contact the NDIA by calling 1800 800 110, visiting one of their offices in person, or visiting ndis.gov.au for further information.

Signature*

Date of Agreement*