• NDIS Service Agreement

    Please complete this form for Plan and Self Managed Clients
  • Side by Side Psychology Therapist/s agrees to provide intervention and supports that are in line with the goals for the client named below.  

    Parents or Guardians are asked to complete this agreement on behalf of their child or young person in their care.

  • The sessions will occur at the above described frequency, unless circumstances change to increase or decrease to meet therapeutic goals and to provide a safe and ethical service.

    This will be done in full communication with the client and their immediate support people/family. The content of these sessions will be to work directly on the goals the client (and their family) has identified.

     The therapist will also provide a Review Report at the conclusion of the yearly plan that will be charged at the hourly session rate for 2 hours writing/preparation time.

  • Payment Agreement

    The current session fee is $210 per 60 minutes, which includes 50 minutes face- to-face delivery and 10 minutes to document case notes and session preparation. This fee is commences 1st August 2020 until the 30th June 2021.

    The initial consultation will be $230 to cover initial file preparation time.

    For Plan Managed clients, an invoice will be sent for payment to be made directly to Side by Side Psychology accounts. There is an expectation that these should be paid within 7 working days. Should there be any gap between the session fee and the NDIS payable amount, then this is for the client to pay on the day.

  • Email Fee Schedule

    Reading email updates from client and other practitioners will not be charged, however if there is an expectation for a lengthy update (one that will take more than five minutes), then the following fee schedule will apply (with client agreement).

    Emails that take under 5 minutes to complete will continue to be free (valued at $20)

    Emails written that take between 5-15 minutes will be charged at $40      per email.

    Emails, reports and brief update letters that take up to between 30 and 60 minutes to complete, will be charged at $120 per item.


    Review reports will be charged at the session rate of $210 per 50   minutes.

    Emails and letters to General Practitioners/Paediatricians will continue to be free of any charge.

    Phone call/Video Call Fee Schedule

    Phone call consults will be need to be scheduled in with parents or the third party professionals (such as school staff, other allied health staff) and written consent will be required before they commence (email agreement is sufficient).

    Phone calls in between sessions are unlikely to happen without an allotted appointment time. You will be sent an email asking that a time for this phone call can take place and to agree to the fees set out below.

    Phone calls will be charged in 15 minute allotments:
    5-15 min: $60
    30 min: $120
    45min: $180
    60 min: $240

  • Location of Services

    Intervention services will be provided at the current Side by Side Psychology offices at 161 Lime Avenue, Mildura, Victoria, Australia or via Telehealth or other arrangement that the client agrees to and is in line with providing the agreed upon service.

  • Out of Office Sessions
    Sessions comleted off-site (whether at a community location or at the clients residence) will incur travel time changed at the pro-rata of the session fee. Sessions may occur off-site if this is determined to be required to best meet the goals of the session.

    If there is any disagreement or concerns the client and their supports have, they are encouraged to raise these directly with the therapist.

    The therapist is also able to end therapy sessions with the client if they are certain that they have met their goals on their plan or they are not complying with the agreement regarding attendance and payment of sessions.

  • Cancellation Policy

    The client is required to inform Side by Side Psychology of inability to attend as soon as they are aware. The policy for all clients of the practice stipulates that the client will be asked to pay for the allocated appointment time if the cancelled appointment cannot be filled. Staff make every attempt to fill cancelled appointments and the following guidelines around timelines exist as per the agreement in the Explanation and Consent Form documents.

  • Codes of Conduct

    The therapist agrees to provide therapy in accordance with the rules Psychologists are bound to under the Allied Health Practitioner Regulation Agency (AHPRA) and the Psychology Board of Australia (PBA). The therapist also abide by the Charter for the Australian Psychological Society (APS).

    This agreement is made between the client (if over 18) or a Parent/Guardian for those under 18 years of age.

  • This agreement is also made in conjunction with the Consent Form and the Explanation of Service document being agreed to and signed.

  • Browse Files
    Cancel of
  • Should be Empty:
Jotform Logo
Now create your own JotForm - It's free! Create your own JotForm