NDIS

NDIS Service Agreement

1. Parties

This Service Agreement is for:

Client First Name *

Client Last Name *

Client Date Of Birth *

NDIS Number *

Client Email *

Client Phone Number

Client Address

Street address

City

State

Postcode

Emergency Contact Name & 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 Fortify Movement & Health

3. Schedule of supports

Fortify Movement & Health agrees to provide the client with Allied Health 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/client representative and are not included in the cost of the supports.

4. Fortify Movement & Health Responsibilities

Fortify Movement & Health agrees to:

Review the provision of supports at least annually with the client;
Once agreed upon, 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 Fortify Movement & Health cancellation policy;
Listen to the client’s feedback and resolve problems quickly;
Give the client a minimum of 24 hours notice if Fortify Movement & Health has to change a scheduled appointment to provide supports;
Give the client the required notice if Fortify Movement & Health 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 Fortify Movement & Health about how they wish the supports to be delivered to meet the client needs;
Treat Fortify Movement & Health workers with courtesy and respect;
Talk to Fortify Movement & Health if the client has any concerns about the supports being provided;
Give Fortify Movement & Health the required notice if the client cannot make a scheduled appointment, noting that if the notice is not provided, Fortify Movement & Health's cancellation policy will apply;
Give Fortify Fitness the required notice if the client needs to end this Service Agreement (see 'Ending this Service Agreement' below for more information); and
Let Fortify Movement & Health know immediately if the client's NDIS plan is suspended or replaced by a new NDIS plan, or if the client stops being a participant in the NDIS.

6. Payments

Fortify Movement & Health will seek payment for their provision of supports after the supports have been delivered.

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, Fortify Fitness 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, Fortify Fitness will claim payment for those supports from

Plan Manager Provider Name *

Plan Manager Accounts 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 Fortify Movement & Health feedback or is not happy with the provision of supports and wishes to make a complaint, the participant can talk to Matt Elphick on 03 8383 3604 or email info@fortifyfitness.com.au

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 Fortify Movement & Health we value consistent and high-quality intervention. If you need to cancel an appointment it is recommended it occur 24 hours before the day before your appointment to avoid a cancellation fee. If you contact Fortify Movement & Health within 24 hours of your appointment or on the day of your appointment there will be a cancellation fee of 100% charged to your account and payment due at your next appointment. Should your therapist arrive at your scheduled appointment and participant are not at home or at the location of the appointment with no prior notice, the scheduled session including travel will be charged at 100% of the scheduled fee for that session. Where Fortify Movement & Health cancels support due to operational reasons, the service will be rescheduled at no penalty to either party. Where multiple cancellations or no-shows occur in a 12-month period, Fortify Movement & Health will initiate contact with the family and their support network to establish the supports we are providing is best suited to the family dynamics and the needs of the participant .

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 *

Fortify Movement & Health can be contacted on:

Name *

Practice Number

Practice Email

Postal Address

13. Schedule of supports

I/we agree to pay for treatment/ therapy sessions provided by Fortify Movement & Health through claiming against the National Disability Insurance Scheme (NDIS) service plan. Working with the NDIS we have been allocated Exercise Physiology and/or Physiotherapy and/or Therapy Assistant services funding for the service year (enter service dates)

Start Service Date *

Finish Service Date *

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

Exercise Physiology/Physiotherapy/Allied Health Assistant assessment and support
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

Fortify Movement & Health 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 *

WeeklyFortnightlyMonthly As scheduled

Where the support will be provided *

Clinic

Please advise of support category participant has approved funding For Exercise Physiology

item: 12_027_0126_3_3 - Advice provided by an Exercise Physiologist regarding exercise requireditem: 15_200_0128_1_3 - Assessment Recommendation Therapy or Training - Exercise Physiologist

Please advise of support category participant has approved funding For Physiotherapy

item: 01_721_0128_1_3 - Assessment Recommendation Therapy orTraining Supports - Physiotherapistitem: 15_055_0128_1_3 - Assessment Recommendation Therapy orTraining - Physiotherapist

Please advise of support category participant has approved funding for Personal Training

item: 12_029_0126_3_3 - Personal training provided by a Personal Trainer to a participantitem: 04_104_0125_6_1 - Access Community Social and Rec Activ - Standard - Weekday Daytimeitem: 15_053_0128_1_3 - Therapy Assistant - Level 2

Price & Payment Information

Exercise Physiologists will be charged at the following rates:

Initial Consultation $110 inc G.S.T
Review Consultation $95 inc G.S.T
NDIS Requested Reports $330 inc G.S.T

Physiotherapists will be charged at the following rates:

Initial Consultation $110
Review Consultation $95
NDIS Requested Reports $330

Therapy Assistants will be charged at the following rates.

Initial Consultation $85.00
Review Consultation $75.00
NDIS Requested Reports $330

Please note the above rates fall in line with our clinics' private fees for 30-minute appointments.

Total Allcoated Funding

Additional funding information

14 . Supporting Documents

Uploading supporting documents such as occupational therapy reports, NDIS reports, NDIS plans, and NDIS goals is highly beneficial for ensuring that the services you receive are tailored to your unique needs and aligned with your overall plan. This also allows us to assist in our NDIS plan reassessment reports.

Please Upload Supporting Documentation

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NDIS Reports and Plans

15 . Agreement signatures

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

Signature of Client Representative *

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Name of Client Representative *

Signed Date *

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