Service Agreement

Below is the service agreement outlining the support services to be provided by Gotcha Covered! Support Services to NDIS clients who are self or planner managed. This form is completely digital. We greatly appreciate this being filled out prior to your first meeting.

You may request a physical copy be sent to you by emailing us at accounts@gotcha-covered.com.au.

    General Information











    Plan Management:
    Self-ManagedPlanner-Managed

    NDIS Plan provided to Gotcha Covered! Support Services:
    I am self-managed and only providing my goals (attached to the bottom of this form).I am planner-managed and providing a copy of my plan (attached to the bottom of this form).I do not have a copy of my plan to provide.I am not providing a copy of my plan.





    Participant Responsibilities 

  • I agree to provide the required sections of my NDIS plan to ensure services can be provided as funded by the NDIS.
  • I am aware that sessions alone may not be sufficient to demonstrate progress. Therefore, I agree to actively participate in the intervention sessions and understand that Gotcha Covered! Support Services may recommend additional activities outside of sessions. 
  • I will advise Gotcha Covered! Support Services of any changes to my personal details (contact number, address) or details of my NDIS plan (additional allied health professionals involvement, plan amendments etc.). 
  • I understand that it is my responsibility to inform Gotcha Covered! Support Services as soon as possible but at the latest 12 hours prior to the appointment, if the participant is unable to attend sessions. If cancellations or failure to attend occurs, 90% of that appointment fee will be charged. Please note: up to 6 hours of cancellation fees may be charged.
  • I am aware that I can cease intervention services at any time. I commit to advise Gotcha Covered! Support Services if I intend to leave the service and that already provided services will be invoiced and I commit to pay them within 2 weeks.
  • I agree to complete payment via direct deposit to Gotcha Covered! Support Services, following each session being completed in a timely manner.

  • Provider Responsibilities 

  • Gotcha Covered! Support Services is committed to provide services in a holistic, individual and family centred way. This includes detailed intervention planning and goal setting to ensure all parties involved are working towards the same objective. 
  • Gotcha Covered! Support Services agrees to treat all information provided to them as private and confidential and will ensure safe and secure storage of any written documentation. 
  • Gotcha Covered! Support Services will send an email or text message reminder 24 hours prior to your appointment to allow for sufficient time to reschedule sessions if necessary. 
  • If Gotcha Covered! Support Services is unable to provide services due to illness, you will be advised as soon as possible. 
  • Gotcha Covered! Support services will invoice appointments within 48 hours of completion of intervention session. 
  • We endeavour to undertake “minimum risk” when supporting the participant. If needed, an appropriate degree of physical contact may be used to ensure the safety of the participant.

  • Agreed Services to be conducted by Gotcha Covered! Support Services:

  • Occupational Therapy (Individual and group therapy sessions including physical/phone/video consultations, reporting and planning, travel, liaising with required support personnel)
  • Total amount allocated to Gotcha Covered! Support Services: $

  • Therapy Assistant (Individual and group therapy sessions, reporting and communication with parents and support personnel)
  • Total amount allocated to Gotcha Covered! Support Services: $

  • Support Worker (Social and community access sessions (individual and group), reporting and communication with parents and support personnel)
  • Total amount allocated to Gotcha Covered! Support Services: $

    **Service prices are subject to current NDIS NSW/VIC pricing guidelines (Dec 2020), prices are subject to change to reflect current NDIS pricing guide.


    Terms & Conditions:

    This agreement is made according to the rules and goals of NDIS. Gotcha Covered! Support service and you (The participant) agree that this agreement is in line the main ideas of NDIS, including, having more choice, achieving your goals and participating in the community.  

    Preparation time and record keeping will be considered in the hours of service accounted for in your plan. Each appointment will include 15 minutes of documenting and planning as a standard fee. Any additional services such as communication with other stakeholders or resource production (e.g. visuals, social story) will incur additional costs. 

    * A supply of supports under this service agreement is a supply of one or more reasonable and necessary supports specified in the statement of supports included, under subsections 33(2) of the National Disability Insurance Scheme Act 2003 (NDIS ACT), in the participant’s NDIS Plan currently in effect under section 37 of the NDIS Act.

    Privacy Policy

  • I understand that Gotcha Covered! Support Services has to create a confidential record to document all necessary information during my child’s period of intervention. It has been explained to me that the record of my personal information will be kept on a secure, cloud-based database of a third party provider as well as in a computer based database file. All record retention complies with the Information Privacy ACT 2014, the Heath Records (Privacy & Access) Act 1997 (ACT) and the Code of Conduct of the Occupational Therapy Board. 
  • I give general consent to Gotcha Covered! Support Services to obtain and release information regarding my child with other individuals/agencies associated with the education and care of my child, including day care, preschool, school, general practitioner, paediatrician, specialist or other allied health professional.
    YesNo

    Alternatively, if you would like to provide only limited consent, please specify who Gotcha Covered! Support Services is permitted to release information to:


    I give general consent to Gotcha Covered! Support Services to transport the participant via car or taxi:
    YesNo


    Guardian/Parent:
    I understand and agree with the information in this service agreement.

    Please attach any relevant or supporting documentation such as a copy of the participant's NDIS plan or goals.

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