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Service Agreement Appendix A & Privacy Policy

Appendix A

1.       What supports will be provided?

1) How will they be provided?

The services will be provided by our mobile Allied Health Team.


2) When will they be provided?

Service will be provided at a time when the participant is home and able to participate in the therapy.


3) Who will provide them?

Services will be provided by Allied Health 2U staff. Where specific staff are designated names can be recorded in the service agreement.


4) How long they will be provided for?

Services will be provided until the goals of the participant are met, the service is no longer required, or as per the participants choosing.


5) How much they will cost?

The cost for the services will be as per the NDIS recent pricing guidelines.

Psychology = $214.41 / hr

Physiotherapy,Occupational Therapy, Speech Therapy and Psychotherapy = $193.99/ hr

Counselling = $156 /hr

2.      What is expected of the participant?

  • Telling the service provider about the supports that you want, and how you want to receive them.
  • Being polite and respectful to the staff who work with you.
  • Telling the service provider if you have got any problems.
  • Telling the service provider if you can’t make it to an appointment – you should always give them at least 24 hours’ notice to avoid a cancellation fee.
  • Telling the service provider straight away if you want to end the Agreement.
  • Letting the service provider know if your NDIS Plan changes or if you stop using the NDIS.
  • For agency and self-managed participants, a copy of the participant’s NDIS Plan may be attached to this Agreement.

3.      What is expected of the service provider?

  • Including you in all decisions about your supports.
  • Letting you know what to do if you have a problem or want to complain.
  • Listening to your feedback and fixing any problems quickly.
  • Telling you if they want to end the Agreement.
  • Making sure your information is correct and up to date.
  • Storing your information carefully and making sure it is providing the services that you have asked for.
  • Being open and honest about the work that they do.
  • Providing the services that you have asked for.
  • Explaining things clearly.
  • Treating you politely and with respect.
  • Obeying all the rules and laws that apply. This includes the National Disability Insurance Scheme Act 2013 and the National Disability Insurance Scheme Rules.
  • Checking whether GST applies.
  • Checking that the Agreement is working well.

4.      How will payments be made?

  • For participants who are plan managed, Allied Health 2U will invoice the plan manager.
  • For participants who are agency managed, Allied Health 2U will invoice the agency directly.
  • For participants who are self-managed, Allied Health 2U will invoice the participant directly and the participant will then recoup the cost from the agency.

5.      How to make changes

  • The changes need to be in writing.
  • The participant and the service provider need to agree on the changes.

6.      How to end the Agreement

If you want to end the Service Agreement, you must tell the service provider. You must let them know before you want the Agreement to end at least four weeks’ notice must be provided. Similarly, if the service provider wants to end the Agreement, they must tell you – and give you notice too.

7.      What to do if there is a problem?

This section explains who to talk to if there is a problem.

If there is a problem please contact the person below.

The contact person is:


Their phone number is:

1300 24 24 28

Their email address is:


If you don’t have any success getting your problem fixed, you can contact the NDIA.

8.      Goods and Services Tax

Most services provided under the NDIS will not include GST. However, GST will apply to some services.

It is the service provider’s responsibility to check whether GST does or does not apply.

By signing this Agreement, the service provider says that they have checked whether GST applies.

Under tax law, the following sentence must be included in this Agreement:

“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 subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the participant’s NDIS Plan currently in effect under section 37 of the NDIS Act.”

9.      The service provider’s contact details

Daytime phone number:

1300 24 24 28

Email address:




Privacy Policy


Allied Health 2U is committed to providing health care which delivers the most optimal outcomes for participants of the NDIS. Below we explain our privacy policy as well as what your rights are while receiving care from us. Further information can also be found in the participant induction pack.


In the course of providing treatment, this practice collects a range of health-related information about you that we consider sensitive.

The practice has a policy that covers how your health information is collected, stored, disclosed & accessed. The practice only collects information that is necessary to provide a quality health service. In the course of providing this service, we may disclose information to your treating doctor and other health service providers from whom you are currently receiving treatment. This includes your NDIS plan manager depending on how your plan is being managed.

You need to let us know if you do not want your health information provided to these health providers or the NDIS however this may also mean we may not be able to provide services to you. In accordance with privacy legislation, you are entitled to access any information that we hold about you. The information which we collect from you will be used for:

  • Administrative purposes for running our service
  • Billing you directly, through the NDIS, or another agency if required
  • Use within our service to ensure you are provided with quality supports and services
  • Disclosure of information to the NDIA, the NDIS Quality and Safeguards Commission, or other government agencies if needed
  • Disclosure of information to health professionals to ensure high quality health care for you if needed
  • Disclosure to other providers in order to provide appropriate services

Marketing and Photos

From time to time we may use photos or videos for marketing purposes including posting onto social media or creating videos. If this is the case we will inform you prior and you can say no. Please note this does not include photos or videos we take during routine consultations which are required for our reports sent to the NDIS or for educating other staff.



By signing the above privacy policy, you are providing Allied Health 2U consent to retrieve

medical information from other resources which may be necessary for your treatment

and/or assessment. Allied Health 2U will maintain all retrieved information private and confidential and will not release to any third party without your prior consent unless otherwise stated in the above policy.


Counselling and Psychotherapy are private sessions aimed at assisting you to work through your concerns so that you can gain a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a relationship between you and a trained Counsellor or Psychotherapist who has the passion and ability to help you achieve your personal goals. The process involves sharing sensitive, personal, and private information that may at times be distressing and may have periods of increased anxiety or confusion. The outcome of sessions is often positive; however, the level of satisfaction for any individual is not predictable. Your therapist is available to support you throughout the therapeutic process.


Throughout the therapeutic process, confidentiality is maintained for all clients except in the following circumstances:

  1. a) You instruct me to tell someone else and provide written permission of this
  2. b) I determine you are a danger to yourself (e.g. self-harm or suicide), to others or someone is a danger to you
  3. c) I am ordered by a court to disclose information
  4. d) The law is going to be, or has been, broken
  5. e) Abuse of children is a mandatory reporting offence which I am bound by law to report
  6. f) For supervision and education purposes (basic information is only shared in this instance, not names or details that would in any way disclose or identify you, the client)

Where confidentiality cannot be maintained, as your Counsellor/Psychotherapist we will take all steps possible to inform/discuss our intention with you.


I have read and understood the information contained in this form and agree to participate in the therapy provided by Allied Health 2U clinicians. I understand that I can leave the session at any time.

Your signature indicates that you have read and understood this form, and any questions you have had about this form have been answered to your satisfaction. 

Strictly no video or voice recording of sessions is permitted without prior consent.

Mobile contact hours are strictly 9am – 5pm Monday to Friday. Please contact 000 for medical emergencies.

This practice complies with state, federal and NDIS rules and regulations.