NDIS Service Agreement Signing Page - Scribble Children's Therapy - {{gravity-field-id-137}}


Please review and sign this Service Agreement if you would like to book an appointment.

NDIS Service Agreement Signing Page

 

The name of the NDIS Participant:

 

The name of the Participant’s representative 

(Parent/Family Member /Child Representative/Other):

 

The name of the Service Provider:

Scribble Children’s Therapy

 

Commencement date of Service Agreement:

 

 

NDIS Plan Details

A copy of the Participant’s current NDIS plan is required to be supplied for a service to commence. If you have not uploaded your NDIS plan to the previous page, please email the file to admin@scribblechildrenstherapy.com.au.

 

NDIS Number:

 

 

Current Plan Start & End Date: 

 

Funding Management:

 

If plan managed, name of plan manager:

 

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

Privacy Policy

As part of providing allied health services to you, our therapists and administrative team will need to collect and record personal information from you that is relevant to your situation. The personal information that we collect 
and store include, your name, contact information, medical history and other relevant information as part of
providing services to you. This collection of personal information will be a necessary part of the assessment and therapy that is conducted.


Your personal information is gathered as part of your assessment and therapy, kept securely and, in the interests of your privacy,  used only by your therapist and the authorised personnel of the practice, as necessary. Your personal information is retained in order to document what happens during sessions and enables the
therapist to provide relevant and informed services to you.


All information obtained during therapy is kept confidential and secure, except when:
(1) It is subpoenaed by a court;
(2) Failure to disclose the information would place the client or another person at risk of harm;
(3) Your (parent and/or young person where appropriate) prior approval has been obtained to:
(a) provide a written report to another professional or agency, e.g. National Disability Insurance Agency, school, health professional
(b) verbally discuss the material with another person, e.g. a parent, educator, health professional

Cancellation Policy

A cancellation is a short notice cancellation if the client:
• does not show up for a scheduled support (including face to face, Telehealth, phone consultation) within a reasonable time, or is not present at the agreed place and within a reasonable time when the provider is travelling to deliver the support; or
• has given less than two (2) clear business days notice for a support.

Please understand that appointment times are limited. If your cancellation is made without 48 clear business hours notice (not including weekends or Public Holidays or before/after business hours), the full session fee will be applicable (including travel fees), and must be paid prior to your next appointment.

If your appointment is on a Monday you will need to cancel/reschedule by Thursday the week before to be within 48 business hours.


You may receive an SMS appointment reminder 48 hours before your appointment reminding you of your appointment. If you need to cancel or reschedule, it is important that you email cancellations@scribblechildrenstherapy.com.au

The text message reminder is provided by the company as courtesy. Failure to receive the text message reminder, does not waive the cancellation fee. Therefore, it is important to note your appointments at the time of the booking.

The cancellation fee applies to illness and other unforeseen circumstances.

Scribble Children’s Therapy reserves the right to discharge the participant should two consecutive appointments be cancelled, or the participant may be returned to our waiting list.

Please note that 100% of the cancellation fee is claimable from the participant’s NDIS budget. Please note that Medicare and private health insurance rebates are not able to be claimed for cancellation fees.


The family are aware that Scribble Children’s Therapy will be invoicing a cancellation fee or directly charging the client’s credit card for the appointment missed which will be payable by the family (not NDIA) prior to any further appointments being scheduled.


Late Attendance Policy

We understand that there are times when children and families arrive late for appointments. In order to respect clients with subsequent appointments in the day, your appointment must finish on time, and the full appointment fee will still be charged.

Lockdown Policy
In the event of a lockdown or during government-placed restrictions, Scribble Children’s Therapy offers alternative services. These services include Telehealth, homework packs and parent sessions - so we may continue to offer therapy services to our Participants during this time.

The Participant’s primary contact will be contacted via phone or email to notify the change of appointment and will be provided with an option of video/phone consultation, homework pack or parent session. Failure to provide 48 hours business days notice will incur 100% of the full session fee.

Please understand that our appointments are limited and we are unable to hold appointments. Therefore, if the Participant is unable to participate in services (missing consecutive appointments), the appointment slot will be offered to others on the waiting list. Scribble Children’s Therapy will not be able to guarantee this time slot once returning to face-to-face services and the Participant will return to the waiting list.

All cancellations made without 48 hours business days notice will incur the regular cancellation fee. Scribble Children’s Therapy reserves the right to discharge the Participant should two consecutive appointments be cancelled, or the Participant may be returned to our waiting list.

Changes to service delivery
We kindly ask that you provide our therapists with 24 business hours notice to swap your appointments from face to face to Telehealth/homework pack or vice versa.

Discharge Policy
• Scribble Children’s Therapy reserves the right to discharge a Participant should two consecutive appointments, or multiple appointments a term, be cancelled, or the Participant may be returned to our waiting list.
• Scribble Children’s Therapy reserves the right to discharge a Participant if the Participant fails to pay invoices as per the payment terms of 7 days (plan managed) / 1 day (self-managed).
• If a cancellation is made by the Participant or there is a failure to attend an appointment and contact is not made to Scribble Children’s Therapy by the Participant within one week, Scribble Children’s Therapy will discharge the Participant from our service.

Payment Policy
• For in-clinic, telehealth and mobile sessions payment will be charged to the Participant’s credit card at the time of the appointment (applicable to self-managed clients). A dishonour fee of $15.00 will be added in the event that there are insufficient funds in the client's account.
• Should a Participant exhaust funds within their NDIS plan and invoices remain outstanding, the Participant will be responsible for the payment of these invoices.
• Should an agency (NDIS) managed Participant access services from Scribble Children’s Therapy, the Participant will be responsible for the payment of services received.
• In the case that the plan manager is unable to pay invoices, debt will be forwarded to the Participant to make payment.
• Should the Participant decline payment, debt will be forwarded to a debt collector, and be escalated to the NDIA or ombudsman. All costs of debt recovery and legal expenses can be charged back to the client should the client force Scribble Children’s Therapy to commence debt/legal proceedings.

Card on File Policy

Scribble Children’s Therapy requires all clients to provide credit card information which will be kept on file. Your private information is securely stored and encrypted in our practice management system. This means, once initially entered and captured, your credit card details are not visible to anybody within the clinic. Scribble Children’s Therapy reserves the right to use your credit card information for charges incurred for cancellations, missed appointments, services delivered to you or past due account balances. If your card on file is charged, you will be provided with a receipt.

Feedback, Complaints, Preventing and Managing Conflict Policy
Scribble Children’s Therapy is committed to constant improvement, progress, and innovation. We value the experience of our clients and others who interact with our clinic, and act to uphold their right to receive quality service. We recognise that sometimes things can go wrong, and we aim to take action when this occurs. Complaints from clients, the public and professionals are taken seriously as a valued avenue for accountability and opportunity for improvement.

Scribble Children’s Therapy is firmly committed to ensuring a positive and professional environment in which all people are treated with respect and dignity. Scribble Children’s Therapy expects people to treat each other with respect and will take action to prevent or eliminate behaviour that disrupts the operation of the clinic network or affects the ability of individuals to perform their responsibilities with self-respect, creates a hostile work environment, impedes individuals from carrying out responsibilities in a professional manner, interferes with client safety or quality of care.

We kindly ask that you treat our employees courteously, respectfully and with dignity. Scribble Children’s Therapy reserves the right to discharge the Participant should the Participant demonstrate disruptive conduct.

Disruptive conduct includes a single serious incident, or a series of repeated incidents, which affect the ability of other individuals to perform their responsibilities in a respectful environment, such as:

  • verbal, written, or physical intimidation; shouting, berating, or hanging up;
  • attacks, threats or other conduct (physical or verbal) directed at employees, clients, or family members, which are personal, inappropriate, or exceed the bounds of fair and decent behaviour.

Scribble Children’s Therapy recognises that you have a right to provide feedback, lodge complaints, raise suggestions, resolve grievances and commend good performance.

We kindly ask that if you would like to take any of the aforementioned actions, to please email Scribble Children’s Therapy directly via contact@scribblechildrenstherapy.com.au to ensure that there is written record of the complaint/feedback.

 

Responsibilities of the Provider (Scribble Children’s Therapy)

The Provider agrees to:

  • Collaborate with the Participant and the Participant’s family to deliver therapeutic supports.
  • Treat the Participant and the Participant’s family with courtesy and respect.
  • Develop and monitor a therapy plan, comprising of direct and indirect supports and to conduct regular goal reviews.
  • Consult with the Participant’s other stakeholders and support networks as appropriate, for example, Paediatrician, therapists, teachers
  • Provide the Participant the required notice if the Provider needs to end the Service Agreement (see ‘Ending this Service Agreement’ below for more information)


Responsibilities of the Participant / Representative

The Participant/Representative/Nominee agrees to:

  • Inform the Provider about how they wish the supports to be delivered to meet their needs, along with their therapist's recommendations
  • Actively participate in therapy sessions and recommended therapy home programs to develop their child’s skills in order to generalise skills taught in sessions into their child’s everyday life 
  • Liaise with the Provider if the Participant has any concerns about the supports being provided 
  • Adhere to the 'Payment Policy', including, providing upfront payment for reports and assessments
  • Give the Provider a minimum of 48 hours business hours notice if the Participant cannot make a scheduled appointment; and if the notice is not provided by then, the Provider’s cancellation policy (100% cost of session fee) will apply. Weekends, Public Holidays or before/after business hours are not considered business days (see ‘Cancellations’ below for more information)
  • Refer to the ‘Fee Schedule’ document to view fees, which can be requested from the administration team. Please note fees are subject to change at any time.
  • Should the Participant/Representative/Nominee cause harm or damage, the Participant/Representative/Nominee agrees to pay the cost of any damages caused to the Provider’s premises, resources, toys or furniture.
  • Immediately notify Scribble Children’s Therapy if the Participant’s NDIS plan is replaced by a new plan or the Participant stops being a Participant in the NDIS or the amount in the Participant’s plan is running low.

Goods and Services Tax (GST)

A supply of supports under this Service Agreement is a supply of one or more reasonable and necessary supports specified in the statement of supports included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS Plan currently in effect under section 37 of the NDIS Act.

Changes to this Service Agreement

Scribble Children’s Therapy holds the right to make changes to this agreement and changes to the fee schedule without notice.

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. 

I hereby acknowledge that I have thoroughly read, understood and agree to abide by the Privacy Policy, Cancellation Policy, Clinic Policies, and Fee Schedule. I understand that failure to abide by the above will result in the cessation of my services.

 

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Signature Certificate
Document name: NDIS Service Agreement Signing Page - Scribble Children's Therapy - {{gravity-field-id-137}}
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