NDIS Service agreement and consent form

This Service Agreement is made for the purpose of providing supports under the Participant’s National Disability Insurance Scheme (NDIS) plan and documents a personalised and self-directed support arrangement between the Participant and the Positive Psychology Centre which provides the Participant the flexibility and authority to determine their chosen supports to achieve their potential/aspirations and control their own life.  Any changes to the services or support listed in this agreement will require prior authorisation from all parties.

This NDIS Service agreement is made between:

And Positive Psychology Centre Pty Ltd

883 Nepean Hwy, Mornington 3931

P | 03 9664 9069 or NDIS team: 03 5925 9277 / 03 5975 8881

E | ndis@positivepsychology.net.au

Key contact: Cathy Caballero, General Manager

Fee schedule

Our fees are in alignment with the national NDIS price guide. The NDIS price guide is subject to change and Positive Psychology will adjust the rates according to the pricing guide announcements.
The latest version of the NDIS Price Guide is available on the NDIS website: (http://www.ndis.gov.au/providers/pricing-arrangements)

We provide support under the following categories:

Capacity Building - Improved Daily Living:

• $252.99 for 15_054_0128_1_3: Assessment, Recommendation, Therapy or Training (including Assistive Technology) – Psychology. (Psychologist)

• $252.99 for 15_054_0128_1_3 I IDL - Plan Reassessment Report at $252.99 per hour

• $252.99 for NDIS Non-Attendance Fee (IDL 15_054_0128_1_3) 
  

• $252.99 for 15_054_0128_1_3: NDIS-PROV I IDL-Psychology Session - Improved Daily Living Skills, Assessment and/or Therapy (Provisional Psychologist)

• $252.99 for 01_700_0118_1_3: Assessment, Recommendation, Therapy or Training - Early Childhood - Psychologist (including Provisional Psychologist)
  

• $193.99 for 15_056_0128_1_3: Assessment, Recommendation, Therapy or Training (including Assistive Technology) - Other Therapy (Social Worker)
  

• $252.99 / $193.99 per hour for any admin related billing, e.g. letters of support, phone calls, care team meetings, etc.
  

Please note that clients will be charged a full fee for any non-attendances and cancellations made on the day or when not giving the required minimum notice by 9am the previous business day of the appointment.

The supports provided under this Service Agreement

• When will supports be provided: Sessions will be scheduled with the participant – as recommended and agreed upon with participant and/or representing family member/care team member
  

• Who will provide the supports: the Psychologist and Mental Health Social Worker at Positive Psychology who has been selected to provide psychological therapy supports
  

• How will supports be provided: Services will be provided at Positive Psychology Centre or via Telehealth (Video or Phone Conference)
  

• Method of payment for services: Services will be invoiced on the day of service delivery. Invoices will be payable within seven (7) days. Self-managed NDIS clients are billed at the time of their appointment and expected to pay at reception. 
  If for some reason the fees cannot be paid for a particular period, the client or family is required to contact the NDIS team at Positive Psychology Centre with an explanation as to the problem and ways for this to be resolved.

• Funding allocation for psychology services: it is the responsibility of the client / plan nominee / support coordinator / plan manager to ensure funding has been set aside for the psychology services and that booked appointments will be paid. 
  Our administrative team does not have the capacity to monitor whether the funding has actually been set aside for psychology services.

Client's rights and responsibilities

Whilst accessing services outlined in this Service Agreement as a client of Positive Psychology, I the Participant:

• Have the right to be treated with dignity and respect and to have my choices and aspirations supported as far as is reasonably possible

• Have the right to participate in the development of my support plan acknowledging that the cost of supports arising from that plan must be able to be met within the funding available for this support (unless I have other income sources). Any support plan will be reviewed annually or can be reviewed upon request by me or Positive Psychology at any time.

• Have the right to privacy and confidentiality and in keeping with the Health Records Act 2001, to request access to any health information kept by the Positive Psychology Centre.

As a client, family member or support coordinator I will:

• Treat staff and other clients with courtesy and consideration at all times

• Respect the needs and opinions of all clients and staff

• Keep Positive Psychology Centre informed of any changes in my personal life such as where I live and any changes in medication

• Work cooperatively with Positive Psychology Centre regarding issues arising during the development and delivery of support and activities covered by this agreement

• Pay all fees owing by the due date

• Adhere to the budgetary requirements of my service plan

• Provide Positive Psychology Centre with 1 months' advance notice of intention to leave the service in writing.

• Inform Positive Psychology about the supports that I want and how I want to receive them

• Participate in the development and regular review of my support plan.

• Inform Positive Psychology if your NDIS Plan changes or if you stop using the NDIS.

Positive Psychology's rights and responsibilities

In agreeing to provide this support arrangement, Positive Psychology Centre:

• Will treat information about the client and their activities as private and confidential in line with the client’s wishes and with privacy legislation

• Will provide the client with 1 months’ notice of intention to cease service provision in writing

Complaints and disputes

The Positive Psychology Centre recognises that clients and their carers have a right to provide feedback to our staff and management, to raise suggestions, resolve grievances and commend good performance and encourages all clients to speak up when they are not happy with any part of our service. If you would like to share any feedback or address any concerns, please raise them with the NDIS team at The Positive Psychology Centre who can be contacted as per the details listed below.

Cancellation policy and payment

When you make an appointment to see one of the psychologists, we reserve the whole hour for you; approximately 50 minutes for the appointment and 10 minutes for notes and admin.
If for some reason you need to cancel or postpone your appointment, you must let us know by 9 am the business day before your appointment. This is to allow time to offer the appointment to another client who may be on a cancellation list waiting for an appointment.  

The cancellation fee must be paid before rebooking if there has been insufficient cancellation notice or non-attendance to an appointment. Any outstanding cancellation / non-attendance fees must be paid in full before your next appointment.

All clients are required to make full payment for their session on the day of consult (unless other payment arrangements have been made with a third party). 

Payment policy self-managed clients:

Appointments are to be paid at the time of the appointments and payment receipt will be emailed upon completion of payment at reception. A secure credit card form will be provided upon booking your first appointment(s).

You're welcome to contact the NDIS team via ndis@positivepsychology.net.au in case of any questions.

Please confirm that you have read, understood and agree to these conditions, please sign below:

Cathy Caballero, authorised signature for Positive Psychology Centre