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: .
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:
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.
The Kooky Clinic agrees to:
The agrees to:
The Kooky Clinic will seek payment for their provision of supports after the confirms satisfactory delivery.
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.
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.
If the participant wishes to give the provider feedback, the participant can send a message to email@example.com.
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 firstname.lastname@example.org.
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.
For the purposes of GST legislation, the parties confirm that:
The Kooky Clinic reserves the right to vary, replace or terminate this policy from time to time.
The can be contacted on:
The Kooky Clinic can be contacted on:
VoiceMail: 07 3133 8018
Mail: PO Box 1600, Springwood, QLD 4127
Leave this empty:
Your legal name
Your email address
Signed by The Kooky Clinic
Signed On: January 10, 2021
If you have questions about the contents of this document, you can email the document owner.
Document Name: NDIS Service Agreement
Agree & Sign