Service Agreement Form

PERSONS MAKING THE AGREEMENT

The following is a service agreement between Independent Living Care Pty Ltd and the following...

NDIS Support Required:

DURATION OF THE AGREEMENT / PLAN DATES

This Service Agreement is for the Participant stated above, and is for the following period:

My plan is:

1. PRIVACY AND CONSENT -

The collection and use of personal information is in accordance of our Privacy Policy.  In signing this agreement, you consent to us: 

 

  • Collecting personal information for the primary purpose of providing ILC , including collecting such information from third parties where it is unreasonable or impracticable for us to collect it from the Participant 

  • Saving your personal information on our secure CRM (Client Management System) which is able to be accessed by you only those who provide your support

Using and disclosing personal information for the following purposes; 

 

 

  •  ILC services 

  • Administration and operations such as accounting, risk management, record keeping, statistical analysis, planning systems development, testing, staff training and assessing and monitoring the use and performance via internal and external audits. 

  • Other purposes as may be permitted or required under the NDIS Practice Standards

  • For use by our employees, related bodies corporate, agents and contractors 

  • health providers, financial institutions, payment system operators, persons acting on your behalf, regulatory bodies, law enforcement agencies and government agencies.

2. PURPOSE OF THE AGREEMENT - I agree this Service Agreement is made for the purpose of providing support under the Participant’s National Disability Insurance Scheme (NDIS) plan

According to the rules and the goals of the National Disability Insurance Scheme Act 2013 (NDIS Act).

3. FUNDS OVERSPEND

I acknowledge that if I ignore low funding alerts and budgeting notifications and continue accessing supports, I may be responsible to pay for the service myself.

POLICIES, PROCEDURES AND COMPLAINTS

I agree that I am aware of the complaints procedure

INDEPENDENT LIVING CARE AGREES TO: *

 

  • Keep accurate records on the service provided to the Participant 

  • Communicate openly and honestly in a timely manner Treat the Participant with courtesy and respect Listen to the Participant’s feedback and resolve problems in a timely manner 

  • 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 (Competition and Consumer Act 2010-Schedule2)

  • The prices for the services are also described in the Table of Services at the end of this agreement.

  • Have insurance (workers compensation and public liability) that covers the way services are provided

  • Keep clear records about the services provided to the Client 

RESPONSIBILITIES OF PARTICIPANT OR GUARDIAN/AUTHORISED REPRESENTATIVE * 

The Participant or Guardian/Authorised 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 concerns about services being provided.

  • Give the Provider the required notice if the Participant needs to end the Service Agreement and let the Provider know immediately if the Participant’s NDIS plan is suspended or replaced by a new NDIS plan or the Participant stops being a participant in the NDIS.

  • Pay the invoices issued by the Service Provider in connection with the services provided.

GOODS AND SERVICES TAX (GST) *

For the purposes of GST legislation, the Parties confirm that: 

  • a supply of services 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 National Disability Insurance Scheme Act 2013 (NDIS Act), in the participant’s NDIS plan currently in effect under section 37 of the NDIS Act; 

  • the participant’s NDIS plan is expected to remain in effect during the period the supports are provided; and 

  • the participant/participant’s representative will immediately notify the provider if the participant’s NDIS Plan is replaced by a new plan or the participant stops being a participant in the NDIS. 

CANCELATION POLICY

I am aware that if I give less than 24 hour notice for services I will be charged

COMMUNICATION 

I agree that I am aware of the complaints procedure

CONSENT

Please check all three boxes below to give your consent

Please upload a copy of your NDIS Plan and Goals here:

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