Service Agreement

Persons Making the Agreement

The following is a service agreement between Direct Care and the following...

NDIS Participant Name*

First Last

NDIS Number*

Date of Birth*

Contact Phone Number*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent / Representative*

(where applicable)

Alternative Phone Number*

Duration of the Agreement / Plan Dates

This Service Agreement is for the Participant stated above, and is for the following period:

NDIS Plan Start Date*

NDIS Plan End Date*

Continuing Service*

Do you consent to Direct Care providing Plan Management and / or Support Coordination in subsequent NDIS plans unless notified otherwise?

Yes
No

1. PRIVACY AND CONSENT - I give consent to Direct Care to use and retain information and to disclose information (including assessments) if required and as deemed necessary. I consent to my contact details being supplied to providers for the purpose of arranging relevant supports and service agreements*

Adhering to 2.21 Privacy and confidentiality policy.

Yes
No

2. PURPOSE OF THE AGREEMENT - I agree this Service Agreement is made for the purpose of providing support under the Participant’s National Disability Insurance Scheme (NDIS) plan*

According to the rules and the goals of the National Disability Insurance Scheme Act 2013 (NDIS Act).

Yes
No

3. SUPPORTS TO BE PROVIDED - I give consent to the Service Provider to provide the Participant the following supports*

Please download our Service Agreement PDF to see full description of supports. Link at the bottom of page.

Plan Management (described on plan as Improved Life Choices)
Support Coordination (only if stated in NDIS plan). When applicable, travel will be charged at the Support Coordination hourly rate.

4. AUTO APPROVE INVOICES - I give consent to Direct Care to claim invoices relating to my NDIS supports without individual approval*

Yes
No - I want to receive and approve all invoices prior to claiming and I am aware this will need to be done promptly so that my providers are paid in a timely manner

POLICIES, PROCEDURES AND COMPLAINTS - I agree that I am aware of the complaints procedure*

Direct Care have policies and procedures in place, adhering to NDIS Quality & Safeguards Commission regulations. Some policies, including Feedback and Complaints are available on our website at www.directcare.com.au and by selecting Forms. Alternatively, hard copies can be provided upon request by contacting Direct Care.

I agree

CONSENT*

Please check all three boxes below to give your consent

I agree that the details I have provided are true and correct
I have read and agreed to the Service Agreement
I have read and agreed to the Privacy Policy and agree to consent to share information

Persons Making the Agreement

Duration of the Agreement / Plan Dates

CONTACT US TO LEARN MORE ABOUT THE SUPPORTS WE PROVIDE