Please read this service agreement in full prior to signing and dating. It contains important information in relation to the supports that will be provided.

A Service Agreement can be made between a Client or their Authorised Representative (e.g. a parent, guardian or other nominated person) and a Provider.

In this Service Agreement, the term "Party" or "Parties" refers to Wizard Occupational Therapy (Wizard OT) and the Client/Client's Authorised Representative who is making this 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 participation of people with a 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.

The Person that is Authorised to sign this Service Agreement is:

This Service Agreement is made for the purpose of providing supports under the Client's National Disability Insurance Scheme 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.

Wizard OT needs to know that you are happy for your personal information to be collected and stored. He may need to share information about you with other members of your care team. This might include what we are working on and how we are doing it. Only important information relevant to the work that we are doing will be collected, stored and/or shared. In some situations, the law says that information must be shared.

• Client and/or their representative give consent for Wizard OT to take photos and/or videos of the Participant and potentially other people at our appointments for use only with:

• Creating visual supports to help you

• Communicating your needs, for example assistive technology

• Reviewing the session

• Seeing changes over time

• Applying for funding on your behalf

Once the images or videos have served their purpose, they will be destroyed with encryption.

Information will be kept private and not shared without your agreement (except if we legally have to). All information will be kept in a locked file in our workplace and electronically encrypted in cloud based services that adhere to the Australian Privacy Principles.

The Client/Client’s Representative gives consent for relevant information to be shared between the NDIS and the following specific people or organisations (e.g. school, workplace, service coordinator, other professionals, other organisations):

Wizard OT needs to know that you are happy for your personal information to be collected and stored. He may need to share information about you with other members of your care team. This might include what we are working on and how we are doing it. Only important information relevant to the work that we are doing will be collected, stored and/or shared. In some situations, the law says that information must be shared.

• Client and/or their representative give consent for Wizard OT to take photos and/or videos of the Client and potentially other people at our appointments for use only with:

• Creating visual supports to help you

• Communicating your needs, for example assistive technology

• Reviewing the session

• Seeing changes over time
  

Once the images or videos have served their purpose, they will be destroyed with encryption.

Information will be kept private and not shared without your agreement (except if we legally have to). All information will be kept in a locked file in our workplace and electronically encrypted in cloud based services that adhere to the Australian Privacy Principles.

The Client/Client’s Representative gives consent for relevant information to be shared between Wizard OT and the following specific people or organisations (e.g. school, workplace, service coordinator, other professionals, other organisations):

NDIS Occupational Therapy Improved Daily Living Item Code: 15_617_0128_1_3 

NDIS Therapy Assistant (Level 2) Improved Daily Living Item Code:  15_053_0128_1_3

NDIS Occupational Therapy Assistance with Daily Life Item Code: 01_661_0128_1_3

Type of Support:

• Clinical assessment and treatment;

• Clinically relevant communications including phone calls/written programs/communication with other health professionals (any task that takes more than 6 minutes will be invoiced);

• Attendance at team meetings/case conferences;

• Any reports, forms, or letters as required by the NDIS or requested by the Client/Client's representative;

• Cancellation charges for late notice or no show appointments.

Wizard OT reserves the right NOT to provide service or to cancel any future appointments for the Client if they do not have sufficient funds in their plan or their plan expires. 

Price and Payment Information:

The hourly rate is in accordance with the conditions stated in the NDIS Pricing Arrangement.  The hourly rate, travel rates and guidelines for services included (including cancellation policy) will be subject to change, in accordance to changes to the NDIS Pricing Arrangement. The fees are: 

• Occupational Therapy: $193.00 per hour plus $193.00 per hour for any associated therapist travel.

• Therapy Assistant (Level 2): $86.79 per hour  plus $86.79 per hour for any associated therapy assistant travel.
  

Additional expenses are the responsibility of the Client/Client's representative and are not included in the cost of the supports. Examples include entrance fees, event tickets, meals etc.

If the Wizard OT Therapist arrives to a confirmed appointment, and the Client declines service, is not present or does not show up after contact attempts, then both non-attendance of the appointment and any relevant travel will be charged.

Travel

Travel will be charged in accordance with NDIS guidelines. Guidelines currently specify travel to and from appointments is billable at an hourly price limit in the following increments:

- Up to 30 minutes for MMM1-3 areas and;
- Up to 60 minutes for MMM4-5 remote areas or the only or last appointment of the day.

Type of Support:

• Group Sessions held in Wizard OT's dedicated location

• Cancellation charges for late notice or no show appointments

Wizard OT reserves the right NOT to provide service or to cancel any future appointments for the Participant if you do not have sufficient funds in your plan or the plan expires. 

Price and Payment Information:

The hourly rate is in accordance with the conditions stated in the NDIS Pricing Arrangement.  The hourly rate, and cancellation policy, will be subject to change, in accordance to changes to the NDIS Pricing Arrangement. The fees are: 

$110.00 for each 120 min Group Therapy Session which includes materials provided/used.

Type of Support:

• Group Sessions held in Wizard OT's dedicated location

• Cancellation charges for late notice or no show appointments

Wizard OT reserves the right NOT to provide service or to cancel any future appointments if you cannot pay invoices for sessions attended.

Price and Payment Information:

The hourly rate, and cancellation policy, will be subject to change. The fees are: 

• $110.00 for each 120 min Group Therapy Session which includes materials provided/used.
  

Type of Support:

• Clinical assessment and treatment

• Clinically relevant communications including phone calls/written programs/communication with other health professionals (any task that takes more than 6 minutes will be invoiced)

• Attendance at team meetings/case conferences

• Any reports, forms, or letters as required or requested by the client / client representative

• Cancellation charges for late notice or no show appointments

Wizard OT reserves the right NOT to provide service or to cancel any future appointments for the client if they do not have sufficient funds. 

Price and Payment Information:

The hourly rate, travel rates and guidelines for services included (including cancellation policy) are subject to change. The fees are:

• Occupational Therapy:  $193.00 per hour plus $193.00 per hour for any associated therapist travel.

• Additional expenses are the responsibility of the Client/Client's representative and are not included in the cost of the supports. Examples include entrance fees, event tickets, meals etc.
  

If the Wizard OT Therapist arrives to a confirmed appointment, and the Client declines service, is not present or does not show up after contact attempts, then both non-attendance of the appointment and any relevant travel will be charged.

Wizard OT ABN 64 125 922 011

Please note this updated Service Agreement includes

both previously used hours and further requested hours for this Plan period.

Wizard OT will seek payment for their provision of supports after the supports have been delivered in accordance with the Participant's NDIS Plan funding type noted below:

Wizard OT will seek payment for their provision of supports after the supports have been delivered:

Payment is due by Electronic Funds Transfer within 7 days of invoicing. 

All outstanding invoices must be paid before provision of next service. 

Upon request of assessment Report all services involved in completion of Report will be paid for prior to Report being provided.

It is helpful for the Therapist to have a copy of the My Profile and Goals sections of the NDIS Plan. This ensures we are working towards your stated goals. It also helps when applying for funding and completing reports for the NDIS when needed. 

It is your choice whether or not to provide a copy of all or parts of the NDIS Plan.

Wizard OT agrees to;

• Provide Therapy services as per this agreement and in accordance with NDIA procedures.

• Work in collaboration with you to achieve your goals.

• Communicate openly and honestly with you.

• Be polite and friendly and treat you with respect at all times.

• Explain things clearly so you understand every step of the process.

• Include you in all decisions about your supports.

• Listen to your feedback and act quickly upon any complaints you report to us.

• Store your information carefully and maintain your privacy

• Discuss changes to this Service Agreement with you, and amendments to be written and signed by both parties

You agree to;

• Treat all members of Wizard OT with respect.
  

• Notify Wizard OT about any changes you wish to be made to this Service Agreement.
  

• Notify Wizard OT if your NDIS plan changes (e.g. if you have a booked plan review).

• Provide at least 48 hours notice if you wish to cancel a booked service.

• Provide at least 4 weeks notice if you wish to terminate our services. You will be billed for the hours of service provided until the date of termination.

• Pay invoices by the due date.

Wizard OT agrees to:

• Provide Therapy services as per this agreement

• Work in collaboration with you to achieve your goals.

• Communicate openly and honestly with you.

• Be polite and friendly and treat you with respect at all times.

• Explain things clearly so you understand every step of the process.

• Include you in all decisions about your supports.

• Listen to your feedback and act quickly upon any complaints you report to us.

• Store your information carefully and maintain  your privacy
  

• Discuss changes to this Service Agreement with you, and amendments to be written and signed by both parties

You agree to:

• Treat all members of Wizard OT with respect.
  

• Notify Wizard OT about any changes you wish to be made to this Service Agreement.

• Provide at least 48 hours notice if you wish to cancel a booked service.
  

• Provide at least 48 hours notices if you wish to terminate our services.  You will be billed for the hours of service provided to the date of termination.

• Pay invoices by the due date.

Short notice cancellations or non-attendance, where notice is given with less than 2 clear business days before the scheduled appointment, may result in 100% of the appointment fee being charged (except in extenuating circumstances), including any travel (or part thereof) already undertaken. 

The NDIS allows for the Client's Plan to be charged for late cancellations/failure to attend by Clients. If there are frequent cancellations, Wizard OT will contact you to try to understand why they are occuring and see if anything needs to change in the delivery of the therapy services to support the Client. Clients must pay for any cancellation fees not covered by the NDIS.

Repeated cancellations may result in cessation of this agreement.

Should Wizard OT be unavailable due to illness or unexpected personal leave, therapy for that day may be cancelled and the Therapist will attempt to notify you as early as possible; and no charge will be incurred by the Participant for that day’s therapy.

Participants and/or their representative need to contact Wizard OT by phone call or text message on 0451 994 190 to cancel an appointment.

Short notice cancellations or non-attendance, where notice is given with less than 2 clear business days before the scheduled appointment, may result in 100% of the appointment fee being charged (except in extenuating circumstances), including any travel (or part thereof) already undertaken. 

Repeated cancellations may result in cessation of this agreement.

Should Wizard OT be unavailable due to illness or unexpected personal leave, therapy for that day may be cancelled and the Therapist will attempt to notify you as early as possible; and no charge will be incurred by the Client for that day’s therapy.

Clients and/or their representative need to contact Wizard OT by phone call or text message on 0451 994 190 to cancel an appointment.

Outstanding fees need to be paid prior to further services being provided. If fees are not paid, Wizard OT may contact the following (where applicable) to recover the outstanding debt:

• Plan Manager

• Support Coordinator

• LAC

• NDIA

• Debt collector

• The Client/Client's Representative will be liable for any outstanding debts that are not payable by the NDIA and also the costs associated in recovering such debts.

Outstanding fees need to be paid prior to further services being provided. If fees are not paid, Wizard OT may contact the following (where applicable) to recover the outstanding debt:

• Debt collector
  

• The Client/Client's Representative will be liable for any outstanding debts and also the costs associated in recovering such debts.

We will strive to ensure that your experience with Wizard OT is a positive one, however in any instance where you are unhappy with our service, feel free to discuss this with us as soon as possible.  Please be assured that we welcome all feedback and will endeavour to resolve any issues or concerns in a timely manner.

If you have a concern, you can speak directly to Wizard OT:

• Gavin Symes

• T: 0451 994 190                                           

• E: gavin.symes@wizardot.com

If you don’t wish to discuss your complaint with Wizard OT, or if you feel that your issue is not being resolved satisfactorily, you can contact your NDIS Support Coordinator or Plan Manager.  Alternatively, you can contact the NDIA who can provide you with information on what you can do.

NDIA     T: 1800 800 110    W: http://www.ndis.gov.au

We will strive to ensure that your experience with Wizard OT is a positive one, however in any instance where you are unhappy with our service, feel free to discuss this with us as soon as possible.  Please be assured that we welcome all feedback and will endeavour to resolve any issues or concerns in a timely manner.

If you have a concern, you can speak directly to Wizard OT:

• Gavin Symes

• T: 0451 994 190     

• E: gavin.symes@wizardot.com

Should either party wish to end this service agreement they must give at least four week’s notice and if either party seriously breaches this Service Agreement the requirement of notice will be waived, and immediate cessation of service may occur.

By signing this Agreement, you agree to all of the information included. 

Please note, if we do not receive back a signed copy of this Agreement and the Client continues to attend appointments after receiving, it is implied the Client / Client's Authorised Representative have accepted the terms within this Agreement.

I have read & understood this Service Agreement and understand each item listed within. I understand Wizard OT will be engaged to provide services that it is entitled to receive payment in return.

I confirm that authority has been delegated to me the undersigned, to represent the Client and execute this Agreement as the Client's Authorised Representative. 

Signed on behalf of:

Thank you - we will review your response promptly and return an updated form for you to approve.

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