Date

YYYY

1. PARTIES

This Service Agreement is for:

Participant

First Name

Last Name

Date of Birth

YYYY

NDIS Number

Phone

Country

(###)

###

####

Plan Management

Self-Managed

NDIS/Agency Managed

Plan Managed

Representative

Please provide the following information if you have a representative, such as a guardian, support coordinator, or family member, assisting with your NDIS services or acting as a contact for payment of invoices:

Name

First Name

Last Name

Relationship to Participant

(###)

###

####

Phone

Country

(###)

###

####

AND

Neuro Arts WA (ABN 68923002124) `the organisation'. The Organisation hereby agrees to carry out and/or provide the Supports for the Participant in accordance with the Schedules and the Terms attached to this Agreement.

2. THE NDIS AND THIS SERVICE AGREEMENT

This Service Agreement is made to provide supports under the client's NDIS plan. This agreement is made within the context of the NDIS, which aims to: (a) Support the independence and social and economic participation of people with disabilities. (B) Enable individuals with disabilities to exercise choice and control in achieving their goals and managing their supports.

3. SCHEDULE OF SUPPORTS

Neuro Arts WA agrees to provide the client with creative arts therapy services. The supports and their prices are detailed in the attached Schedule of Supports. All prices are GST inclusive (if applicable) and cover the cost of providing the supports. Additional expenses not included in the NDIS supports are the responsibility of the client/client representative.

4. SHEDULE OF SUPPORTS, NEURO ARTS WA RESPONSIBILITIES:

Neuro Arts WA agrees to: * Review the provision of supports at least annually with the client. * Provide supports that meet the client's needs at their preferred times. * Communicate openly, honestly, and in a timely manner. * Treat the client with courtesy and respect. * Consult the client on decisions about how supports are provided. * Provide information on managing complaints or disagreements and details of the cancellation policy. * Listen to feedback and resolve problems promptly. * Give a minimum of 24 hours’ notice if a scheduled appointment needs to be changed. * Provide the required notice if the Service Agreement needs to be terminated (see "Ending this Service Agreement" below). * Protect the client’s privacy and confidential information. * Provide supports in compliance with relevant laws, including the NDIS Act 2013 and Australian Consumer Law. * Keep accurate records of the supports provided. * Issue invoices and statements as per the NDIA Terms of Business for Registered Providers upon request.

5. RESPONSIBILITIES OF THE CLIENT/CLIENT REPRESENTATIVE

The client/client representative agrees to: * Inform Neuro Arts WA about how they wish the supports to be delivered. * Treat Neuro Arts WA workers with courtesy and respect. * Discuss any concerns about the supports with Neuro Arts WA. * Provide required notice if unable to attend a scheduled appointment, following the cancellation policy. * Provide required notice if the Service Agreement needs to be ended (see "Ending this Service Agreement" below). * Notify Neuro Arts WA immediately if the client's NDIS plan is suspended, replaced, or if the client ceases to be a participant in the NDIS.

6. PAYMENTS

Neuro Arts WA will seek payment within 7 days for supports after they have been delivered.

7. CHANGES TO THIS SERVICE AGREEMENT

Any changes to the supports or their delivery will be discussed and reviewed in writing, signed, and dated by both parties.

8. ENDING THE SERVICE AGREEMENT

To end this Service Agreement, either party must provide 2 weeks’ notice. If there is a serious breach of this agreement, the notice requirement may be waived.

9. GOODS AND SERVICE TAX (GST)

For GST purposes, the parties confirm that: (a) The supports provided are reasonable and necessary as specified in the client's NDIS Plan. (b) The client's NDIS Plan is expected to remain in effect during the service period. (c) The client/client representative will notify Neuro Arts WA if the NDIS Plan is replaced or if the client ceases to be a participant.

10. CANCELLATION POLICY

I/we agree to pay for therapy sessions provided by Neuro Arts WA through NDIS funding. Funding has been allocated for the service period: NDIS Pricing Arrangements and Cancellation Fee Guidelines * 24 Hours Notice - No fee will be charged for cancellations made at least 24 hours before the scheduled appointment. * Less Than 24 Hours Notice - A cancellation fee may apply for cancellations made less than 24 hours before the scheduled appointment. Eligibility for Cancellation Claims *Cancellations can only be claimed for supports specified in the NDIS Pricing Arrangements and Price Limits document, and the terms of cancellation must be stated in a signed agreement. Notice Requirement * If you provide the required notice as specified by the NDIA, your provider cannot charge you a cancellation fee Alternative Billable Work * If the provider is able to find alternative billable work in the event of a cancellation, they cannot charge you a cancellation fee. To ensure compliance, you may need to inquire if the staff member was assigned another billable task. Mileage and Other Costs * You cannot be charged a cancellation fee for costs the provider did not incur, such as mileage. Provider Compliance * All providers, whether NDIS-registered or not, must adhere to the NDIS Pricing Arrangements and Price Limits.

11. FEEDBACK, COMPLAINTS, AND DISPUTES

For feedback or complaints, the client can contact: Helen Moon on 0452 387 576 or Email hello@na.wa.com.au. If still unsatisfied, the client can also make a complaint to the NDIS Commission: Online: www.ndiscommission.gov.au Phone: 1800 035 544

12. SERVICE PERIOD

I/we agree to pay for therapy sessions provided by Neuro Arts WA through NDIS funding. Funding has been allocated for the service period:

FROM

YYYY

COSTS

* Arts Therapy is billed at a rate of $193.99 per hour, unless specified otherwise. * A travel fee of $1 per kilometre will apply for distances exceeding 30 minutes. * Initial Intake Session, Duration: 60-90 minutes, will be billed separately to establish the therapeutic relationship, explores the client’s needs, and develop a treatment plan together. * Pricing may be subject to adjustments in accordance with any updates to the NDIS price guide throughout the duration of the service agreement.

TOTAL NUMBER OF SESSIONS DURING THIS PERIOD

A minimum of 6 sessions is recommended for effective progress. Please indicate the total number of therapy sessions required during this period:

6 Sessions (Minimum) Total = $1163.94

8 Sessions Total = $1551.92

12 Sessions Total = $2327.88

NDIS LINE ITEM

15_056_0128_1_3 / 01_741_0128_1_3 – Assessment, Recommendation, Therapy, and/or Training (including Assistive Technology) by Other Professionals $193.99

15_005_0118_1_3 – Capacity Building Supports for Early Childhood Interventions by Other Therapists

15_799_0128_1_3 - Provider Non Labor Costs $1 per KM

FREQUENCY

Frequency of supports will be as follows:

Weekly

Fortnightly

Monthly

LOCATION

Location of supports will be as follows:

Place of Residence

School

Community

Workplace

Hospital/Medical Facility

Residential Facility

AGREED SERVICES

Neuro Arts WA will provide the agreed number of therapy sessions as outlined in the treatment plan, tailored to meet the client's individual needs and goals, in accordance with NDIS guidelines and professional standards. Regular reviews will be conducted to assess progress. Any additional services, such as reports, communication with other professionals, or case conferences, will be invoiced separately, as specified in the service agreement.

AGREEMENT SIGNATURES

The parties agree to the terms and conditions of this Service Agreement.

Date

YYYY

Name

First Name

Last Name

Signature of Participant/Representative

Please type your full name if you are not able to sign electronically.

Therapist Name

Signature of Therapist

Thank you for submitting your form. We appreciate you taking the time to provide this information. A member of our team will review your details and contact you soon to discuss the next steps. If you have any questions in the meantime, please feel free to reach out.

Kind Regards

Neuro Arts WA

Neuro Arts WA Service Agreement

Neuro Arts WA Service Agreement

Service Agreement