NDIS Service Agreement

TFD Services Company Logo

This Agreement is made according to the rules and the goals of the National Disability Insurance Scheme (NDIS).

This agreement is being provided by

TFD Services Pty Ltd – NDIS Provider Number – 4050027380

Purpose of Agreement
The purpose of this agreement is to provide a clear reference of the roles an responsibilities of both parties outlining a clear, concise and measurable description of the psychological support arrangement between Client and TFD Services, which provides the service user the flexibility and authority to determine their chosen supports to achieve their potential and control over their own life. TFD Services agrees to provide the psychological services outlined in this Individual Service Agreement. Any changes to the services in this agreement will require prior authorisation from all parties.
 
How does this Agreement fit in with the NDIS?
This agreement is made in accordance with the rules and the goals of the NDIS is made for the purpose of providing supports under your NDIS plan.
 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 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.

Description of Service
TFD Services provides confidential individual psychological sessions to the client. TFD Services will provide details of services, costs, and other relevant information as an attachment to this service agreement by way of Schedules.

Client Rights and Responsibilities
Whilst accessing services outlined in this Agreement as a client of TFD Services, I have the right to nominate, in writing, an advocate or guardian, who will act in my interests and accept the responsibilities imposed under this agreement.

  • Have the right to be treated with dignity and respect and to have my choices and aspirations supported as far as is reasonably possible
  • Have the right to determine the type and range of activities that I wish to participate in
  • Have the right to request services in accordance with my support plan, provided the request is also in accordance with all applicable legislation
  • Have the right to privacy and confidentiality and in keeping with the Health Records Act 2001, to request access to any health information kept by TFD Services.

As a client or family member, I will:

  • Treat staff and other clients with courtesy and consideration at all times
  • Respect the nature of service delivery, being that of a quiet and confidential environment, and the other clients of TFD Services
  • Keep the Service informed of any changes in my personal life such as where I live and any changes in medication.
  • Work cooperatively with TFD Services regarding the delivery of services
  • Pay all fees owing by the due date

Responsibilities of TFD Services
In agreeing to provide this support arrangement TFD Services:

  • Will respect the rights of the client to determine the range and types of activities they wish to participate in
  • Will provide notification via text message (given an operational mobile number is provided) the business day prior to the scheduled appointment
  • Will treat all information regarding the client private and confidential in line with the client’s wishes and with privacy legislation.
  • Will respect the right of the client to determine the level of service they wish to participate in

Confidentiality
All personal information gathered during the provision of the psychological service will remain confidential and secure, except where:

  • It is subpoenaed by a court, or
  • Failure to disclose the information would place you or another person at serious and imminent risk; or
  • Your prior approval has been obtained to:
    – provide a written report to another professional or agency. E.g. to provide feedback to the GP who prepared a GP Mental Health Care Plan to refer you to the psychologist under the Better Access to Allied Health Services Initiative; or discuss the material with another person, e.g. a parent or employer; or request for report is received with regards to your NDIS plan review.
     
    There are other situations when disclosure of your personal information is permissible without your consent; or in situations when disclosure of your personal information is otherwise required or authorised by law to prevent, investigate or prosecute a crime or offence, e.g. suspected child, elder, dependent adult abuse.  In these circumstances, only the necessary information will be conveyed.
     

Complaints and Disputes
If you have a concern about the management of your personal information or the services provided to you, please contact TFD Services immediately to discuss your concerns. Alternatively please discuss your concerns with your NDIS Case Manager or NDIS directly.
 
Ultimately, if you wish to lodge a formal complaint about the use of, or access to your personal information, or the services provided to you at TFD Services you may contact APHRA directly at www.aphra.gov.au.
 
Service Fees
In schedule 1, attached to this service agreement is the fee schedule for psychological based on the NDIS Price Guidelines. These prices will be review as per the NDIS Annual Price Guide Reviews and align accordingly.
 
Goods and Services Tax
Under the NDIS, GST will not apply to most services. If GST is applicable to your service, it will be detailed in the agreement and Schedule of Supports.
 
Cancellation Policy
If, for some reason you need to cancel or postpone the appointment, please provide notice                 at least 1 business days’ notice prior to the appointment. Cancellations less than 1 business day, or on day of appointment or nonattendance without notification will be charged the cost for the session.
A reminder text message will be sent to the client the business day prior to the scheduled      appointment.
 
Method of Payment for Services
Payment can be made from the funding body direct to TFD Services via PRODA
 
Or
 
Payment can be made via a Case Management Service who is invoiced post session. Invoices will be payable within fourteen (14) days.
 
Or
 
Direct payments from Client. Client makes payment to TFD Services for services received on day of service. Client lodges receipt to NDIS independently from the service for reimbursement of funds.
 
If for some reason the fees cannot be paid for a particular period, the client or family or carer is required to contact the TFD Services with an explanation as to the problem and negotiate ways for this to be resolved. Future appointments will be suspended until all outstanding amounts are renumerated.
 
How to end the Agreement
 
Client:
If you wish to exit or withdraw from this Service Agreement, you are required to provide TFD Services with two weeks’ notice by emailing admin@tfdservices.com.au Client can choose whether to attend appointments within the notification period.
 
TFD Services:
TFD Services will provide a minimum of two weeks written notice if we can no longer meet your needs or sustainably deliver the agreed upon supports and have no option but to withdraw from this agreement. TFD Services will do everything we can to support you in finding another provider who is better suited to deliver supports to meet your goals and aspirations.
If the client does not attend 3 consecutive appointments, TFD Services will attempt to seek clarification as to future engagement. If contact can not be established and a subsequent appointment is not attended, all future appointments will be removed until client contact is received. TFD Services will also seek to engage any support coordination service and seek direction.

NDIS Service Agreement

Name(Required)
DD dash MM dash YYYY
DD dash MM dash YYYY
DD dash MM dash YYYY
Address(Required)

Participant Consent

Consent(Required)
DD dash MM dash YYYY

OR Family Member / Legal Guardian’s signature

Parents / Legal Guardian Name
Participants Full Name
Consent
DD dash MM dash YYYY

Release of Information

Release of Information Consent(Required)
Please note Support Coordinators, Plan Managers and other individuals or organisations relevant to your engagement with our service. Please provide name, relationship to yourself, and contact details – Address and/or phone number

Schedule 1

Service Delivery Options(Required)
Appointment Frequency(Required)
Therapeutic Supports: 15_054_0128_1_3 or 01_701_0128_1_3 $222.99 per session based on NDIS price guidelines. Increases will be based on annual guideline reviews. GST is not applicable on the provision of Therapeutic Supports. Please enter total number of sessions approved for plan period based on frequency.
Payment Method(Required)
Please select which payment method is authorised in your plan.
If Plan Managed, please provide details of plan management company i.e. name and email address for invoices.

Plan Review

Plans are reviewed within session after 6 months and then every 6 months from there.

Plan Goals

Please outline the goals you want to achieve from engaging in psychological supports as noted in your NDIS plan.
Please outline the goals you want to achieve from engaging in psychological supports as noted in your NDIS plan.
This field is for validation purposes and should be left unchanged.