Kooky Clinic

NDIS Service Agreement

NDIS Service Agreement -  




This Service Agreement is for , a participant in the National Disability Insurance Scheme, NDIS ID: (participant), and is made between:










The Kooky Clinic

NDIS Provider: 4050023030

ABN: 97 162 037 498


This Service Agreement will commence from and conclude on , covering NDIS Plan ID: .


The NDIS and this service agreement


This Service Agreement is made for the purpose of providing supports under the participant’s National Disability Insurance Scheme (NDIS) Plan ID: . 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.


Schedule of Supports


The Kooky Clinic agrees to provide the participant therapy services set out in the following Schedule of Supports. The supports and their prices are set out in the following Schedule of Supports. All prices are GST inclusive (if applicable) and include the cost of providing the supports.

Additional expenses (i.e. things that are not included as part of a participant’s NDIS supports) are the responsibility of the   and are not included in the cost of the supports. Examples include entrance fees, event tickets, meals, etc.


Responsibilities of The Kooky Clinic


The Kooky Clinic agrees to:

  • Review the provision of supports at least with the participant
  • Once agreed, provide supports that meet the participant’s needs at the participant’s preferred times
  • Communicate openly and honestly in a timely manner
  • Treat the Participant with courtesy and respect Consult the participant on decisions about how supports are provided
  • Give the participant information about managing any complaints or disagreements and details of the provider’s cancellation policy (if relevant)
  • Listen to the participant’s feedback and resolve problems quickly
  • Give the participant a minimum of 24 hours’ notice if the provider has to change a scheduled appointment to provide supports
  • Give the participant the required notice if the provider needs to end the service agreement (see ‘Ending this Service Agreement’ below 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; keep accurate records on the supports provided to the participant Issue regular invoices and statements of the supports delivered to the participant.


Responsibilities of the  


The   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 any concerns about the supports being provided
  • Give the provider a minimum two business days notice if the Participant cannot make a scheduled appointment; and if the notice is not provided by then, The Kooky Clinic’s Appointment Cancellation Policy will apply.
  • Give the provider the required notice if the participant needs to end the service agreement (see ‘Ending this Service Agreement’ below for more information)
  • 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.




The Kooky Clinic will seek payment for their provision of supports after the   confirms satisfactory delivery.


Changes to this Service Agreement


If changes to the supports or their delivery are required, the parties agree to discuss and review this service agreement. The parties agree that any changes to this service agreement will be in writing, signed, and dated by the parties.


Ending this Service Agreement


Should either party wish to end this service agreement they must give 1 calendar month notice. If either party seriously breaches this Service Agreement the requirement of notice will be waived.


Feedback, Complaints, and Disputes


If the participant wishes to give the provider feedback, the participant can send a message to info@kookyclinic.com.au.

If the participant is not happy with the provision of therapy services and wishes to make a complaint, the participant can send a message to info@kookyclinic.com.au.

If the participant is not satisfied or does not want to send a message, the participant can contact the National Disability Insurance Agency by calling 1800 800 110, visiting one of their offices in person, or visiting ndis.gov.au for further information.


Goods and Services Tax


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

  • A supply of supports 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   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.


Appointment Cancellation Policy


  • Appointments can be hard to find and a long waitlist is in place.
  • We will notify you via email or SMS seven (7) days prior to your appointment.
  • Cancellations with less than one (1) full business day notice will incur a fee equal to 100% of the consultation fee.
  • Cancellations with less than two (2) full business days notice will incur a fee equal to 50% of the consultation fee.
  • Cancellations with more than one two (2) full business days notice will not incur a fee.
  • Access to consultations will be restricted if cancellation fees are owing and future appointments may be cancelled if fees remain outstanding.




The Kooky Clinic reserves the right to vary, replace or terminate this policy from time to time.


Contact Details


The   can be contacted on:





The Kooky Clinic can be contacted on:


The Kooky Clinic

VoiceMail: 07 3133 8018

Email: info@kookyclinic.com.au

Web: https://kookyclinic.com.au

Mail: PO Box 1600, Springwood, QLD 4127


Agreement Signatures


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Signed by The Kooky Clinic
Signed On: January 10, 2021

Signature Certificate
Document name: NDIS Service Agreement
lock iconUnique Document ID: 9611b56608ad2dad530ba1ef281c46bd77ebe002
Timestamp Audit
June 18, 2019 2:12 pm AESTNDIS Service Agreement Uploaded by The Kooky Clinic - info@kookyclinic.com.au IP