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


Scribble Children's Therapy

Service Agreement

The name of the Client

The name of the Client's representative 

(Parent/Family Member /Child Representative/Other)



 

The name of the Service Provider

 

Scribble Children’s Therapy

Commencement date of Service Agreement

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, 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 Client should two consecutive appointments be cancelled, or the Client may be returned to our waiting list.

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 directly charging the client’s credit/debit card for the appointment missed which will be payable by the family, 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 Client's during this time.

The Client'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 the 100% cancellation fee.

Please understand that our appointments are limited and we are unable to hold appointments. Therefore, if the Client 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 Client 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 Client should two consecutive appointments be cancelled, or the Client may be returned to our waiting list.

Changes to service delivery
We kindly ask that you provide our therapists with 24 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 client should two consecutive appointments be cancelled, or the client may be returned to our waiting list.
• Scribble Children’s Therapy reserves the right to discharge a client if the client fails to pay invoices as per the payment terms of 1 day.
• If a cancellation is made by the client or there is a failure to attend an appointment and contact is not made to Scribble Children’s Therapy by the client within one week, Scribble Children’s Therapy will discharge the client from our service.

Payment Policy
• For in-clinic, telehealth and mobile sessions payment will be charged to the client's credit card at the time of the appointment
• A dishonour fee of $15.00 will be added in the event that there are insufficient funds in the client's account
• Debt relating to outstanding accounts will be forwarded to a debt collector. 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.

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 Client should the Client 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 Client and the Client's family to deliver therapeutic supports.
  • Treat the Client and the Client's family with courtesy and respect.
  • Develop and monitor an intervention plan, conducting goal reviews as required
  • Consult with the Client's other stakeholders and support networks as appropriate, for example, Paediatrician, therapists, teachers.
  • Provide the Client the required notice if the Provider needs to end the Service Agreement (see ‘Ending this Service Agreement’ below for more information)

Responsibilities of the Client / Representative

The Client/Representative/Nominee agrees to:

  • Inform the Provider about how they wish the supports to be delivered to meet their needs
  • 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 Client has any concerns about the supports being provided 
  • Provide upfront payment for reports and assessments.
  • Give the Provider a minimum of 48 hours business hours notice if the Client 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 Policy’ above 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 Client/Representative/Nominee cause harm or damage, the Client/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 Client's agreed plan plan is replaced by a new plan or the Client stops being assisted by other funding


Changes to this Service Agreement

Scribble Children’s Therapy holds the right to make changes to this agreement and changes to the fee schedule by providing written/verbal notice.

Ending this Service Agreement

Should either Party wish to end this Service Agreement they must give two (2) weeks notice. If either party seriously breaches this Service Agreement the requirement of notice will be waived. 

Acceptance of Policies and Service Agreement

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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Document name: Other Healthcare Service Agreement Signing Page - Scribble Children's Therapy - {{gravity-field-id-137}}
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March 3, 2023 5:41 pm AEDTOther Healthcare Service Agreement Signing Page - Scribble Children's Therapy - {{gravity-field-id-137}} Uploaded by Scribble Children's Therapy - admin@scribblechildrenstherapy.com.au IP 202.168.44.84
March 3, 2023 5:42 pm AEDTScribble Admin - admin@scribblechildrenstherapy.com.au added by Scribble Children's Therapy - admin@scribblechildrenstherapy.com.au as a CC'd Recipient Ip: 220.245.29.242
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