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Cross Care - Please fill in the Service Agreement 

(Note: if required, this Service Agreement can be translated into different languages. If required, translator can also help explain these terms and conditions)
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Intermediary’s and/or service provider’s responsibilities:

agrees to:

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  1. Make sure service recipient is supported to understand their service agreement and conditions using the language, mode of communication and terms that the participant is most likely to understand

  2. review the service with you in 6 months

  3. treat you with courtesy and respect;

  4. consult you on decisions about how your supports are provided;

  5. work with you to arrange for supports that fit your needs and at your preferred times;

  6. comply with the approved guidelines relevant to the funding;

  7. Listen to your comments and questions and resolve problems quickly;

  8. Keep and provide clear records on services provided to you.

   9.Allow you to update or change the Service Agreement and anytime​​

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Service recipient’s responsibilities:

agree to:

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  1. Review, sign and return copies of monthly expenditure statements in a timely manner;

  2. Report any errors or inconsistencies in monthly reports without delay;

  3. Follow the approved guidelines of the funding;

  4. Work to make sure that the services and supports delivered meet my support needs;

  5. Treat you with courtesy and respect;

  6. Talk to if I have any concerns about the services or supports being provided;

  7. Give reasonable notice(outlined below)should I wish to cease this agreement;

  8. Comply with safe working practices;

  9. Not request support workers to provide services outside the agreement.

  10. Give at least 24 hours notice before the cancellation of a session otherwise a cancelation fee at the value of the booked session may be charged.​

 

Ending this agreement:

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Should either party require this agreement to end, we agree to give 2 weeks notice.

If either party seriously breaches this agreement, then the requirement of notice maybe waived.

Click here to view NDIS price guide 

Click here to view NDIS price guide 

Agreed number of sessions based on NDIS rates:

Signature of Guardian/ advocate: (If service recipient is unable to sign)