NDIS Service Agreement To apply for a NDIS Account with us please fill in the NDIS Form below. Alternatively you can email to info@allcarewarehouse.com.au Please enable JavaScript in your browser to complete this form.Participant First Name *Participant Last Name *NDIS Number (9 digits only): Date of BirthPlan Start DatePlan Finish DateSelect one: NDIA/Agency ManagedPlan ManagedSelf ManagedResponsibilities of Provider The provider agrees to: Once agreed, provide supports that meet the participants’ needs at the participants’ preferred times. Communicate openly and honestly in a timely manner. Treat the participant with courtesy and respect. Consult the participant on the decision about how supports are provided. Listen to the participants’ feedback and resolve problems quickly. Give the participant the required notice if the provider needs to end the service agreement. Protect the participants’ privacy and confidential information. Responsibilities of Participant/Participants Representative Inform the provider about how they wish the supports to be delivered to meet the participants’ needs. Give the provider the required notice if the participant needs to end the service agreement. Let the provider know immediately if the participants NDIS plan is suspended or replaced by a new NDIS plan or the participant stops being a participant in the NDIS. To provide adequate information to the provider so a service booking can be made, and funds claimed whilst remaining under budget. Payments The participant has nominated the NDIA to manage the funding for supports provided under this Service Agreement. After providing supports, Superior Healthcare will claim payment for those supports from the NDIA. If Superior Healthcare is unable to claim the order amount from NDIS the participant will be liable for balance on the account. The Parties agree to the terms and condition of this service agreement. *I agreeParticipant/Representative Name Participant/Representative Email *Participant/Representative PhonePlease upload a PDF copy of the Participant's NDIS plan in the field below. Click or drag a file to this area to upload. If unable to upload, please send a copy of the Participant’s NDIS plan separately to this application by sedning an email of ALL pages to info@allcarewarehouse.com.au Submit