Service Agreement - Easy English

Key Details 

Service Provider (us, we): Communicate to Self-Advocate  

Participant (you, your): ________________________

NDIS Number: ________________________ 


Parent/Guardian (if the participant is under 18 or cannot give consent): ___________________________________

NDIS Plan Start Date: ________________________

NDIS Plan End Date: ________________________


Agreement Start Date: ________________________

Agreement End Date: ________________________


Review Frequency: After the first session, or every 90 days.

Supports and Support Fees

We will provide services to help you meet your goals. We will agree together on which services you need and the costs involved.


Types of Support

  • Face-to-Face Support: Therapy and assessment in person or through telehealth.  

  • Non Face-to-Face Support: Reports, analysis, planning, and resource development.


Payment and Fees

  • We’ll tell you how much the services will cost.

  • You (or your plan manager) must pay your bill within 7 days of the invoice.

  • You may need to pay part of the fee if your NDIS budget doesn't cover the full cost.

  • Any other costs (like extra expenses) are your responsibility.

  • You will be given 24 hours’ notice if we need to change an appointment.


How to Pay for Supports

  • Self-Managed: You pay us directly.

  • Plan-Managed: We send the bill to your Plan Manager.

  • NDIA-Managed: You pay us directly because we are not a registered NDIA provider.


Cancellation Policy

  • If you cancel less than 24 hours before the appointment, you must pay the full fee.

  • If you miss an appointment without telling us, you will also pay the full fee.

  • If you show us a medical certificate within 24 hours after missing the appointment, we may reduce or cancel the fee.


Responsibilities

We will:

  • Provide services safely and according to your needs.

  • Listen to your feedback and make changes if needed 

  • Keep your information private.

You will:

  • Tell us what support you need.

  • Let us know if something is wrong or if you are unhappy with the service.

  • Follow safety instructions and inform us if you need to change or cancel an appointment.


Termination

Either of us can end this agreement by giving two weeks’ notice. If one of us breaks the agreement and doesn't fix it within 7 days, the other can end the agreement right away.


Feedback and Complaints

If you have concerns, please contact us by phone or email.  

Phone: 0494 309 653

Email: liana@communicatetoselfadvocate.com

If you are still not happy, you can contact:

  • Department of Communities or the National Disability Insurance Agency (NDIA).


Acceptance of Terms

By signing this agreement, you (or your parent/guardian) agree to:

  • Notify us if your NDIS Plan changes or if you stop being a participant in NDIS.

  • Communicate with us openly if anything changes that could affect your support.

  • Respect the safety of our staff.

  • Keep track of your NDIS budget to ensure it covers your support fees.

  • Pay for any fees not covered by your NDIS budget.

  • Understand that we may increase fees and that inappropriate behavior will not be tolerated.


Signed by the Participant

Name: _______________________________________________

Signature: _______________________________________________

Date: ____________


Signed by the Participant’s Parent/Guardian or Plan Nominee (if applicable)

Name: _______________________________________________

Signature: _______________________________________________

Date: ____________


Signed by the Provider

Name: _______________________________________________

Signature: _______________________________________________

Date: ____________