This online form will change according to the options you select. Once you submit this form a copy will be sent to our practice for review. A copy of your NDIS Service Agreement will then be emailed to you for you to keep.
The Support Items below correspond with the items under the "Funded Supports" heading of your NDIS Plan. We understand that this part can be tricky. If you have any questions regarding this question please contact our practice manager using our contact page, or by phone on (07) 4637 9989.
Description of Service
Assessment, therapy, training, fitting and any approved travelto deliver support.
Individual specialist interventions to assist a child with disabilityor developmental delay and their family in home, care,community and education settings.
Highly specialised intensive support interventions to addresssignificantly harmful or persistent behaviours of concern.Development of behaviour support plans that temporarily userestrictive practices, with intention to minimise use of thesepractices.
Training for carers and others in behaviour managementstrategies required due the participant’s disability.
The "Total cost of Service Booking" will be automatically calculated based on the information you enter above.
Please read and sign your NDIS Service Agreement on the following page. The fields are prefilled based on the information you entered above. Some of the details can be altered if you need to do so before signing.
This Agreement is made according to the rules and the goals of the National Disability Insurance Scheme (NDIS).
The participant and the service provider agree that this Agreement is in line with the main ideas of the NDIS. These ideas include things like having more choices, achieving your goals and taking part in the community.
Services received from Regional & Rural Mental Health Services will be billed according to the funding model approved by the NDIA.
The participant’s responsibilities include:
Our organization’s responsibilities include:
Regional & Rural Mental Health Services Contact Details
Practice Manager: Andrew Crosby
Phone: (07) 4637 9989
Fax: (07) 4637 9976
If you don't have any success getting your problem fixed, you can contact the NDIA.
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."
Business Address: 137 Russell Street, TOOWOOMBA CITY QLD 4350
Postal Address: PO Box 6097, TOOWOOMBA WEST QLD 4350
Phone Number: (07) 4637 9989
Fax Number: (07) 4637 9976
Email Address: firstname.lastname@example.org
After you have read and signed your NDIS Service Agreement, please complete the captcha field below and click submit.