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NDIS Dietitian Service Agreement 

Please fill out the following form
in order to participate in our activity.

This Service Agreement is for the period until: 


This Service Agreement is made for the purpose of providing therapy services under the participant’s NDIS plan. The parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme that aims to: 

  • Support the independence and social and economic participation of people with disability, and

  • Enable people with a disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports.

Responsibilities of Dietitian SJ 

Dietitian SJ agrees to: 

  • Review the provision of Dietary services at each occasion of service with the participant 

  • Once agreed, provide Dietary services that meet the participant’s needs at the participant’s preferred times

  • Communicate openly and honestly in a timely manner

  • Treat the participant with courtesy and respect

  • Consult the participant on decisions about how treatment is provided

  • Listen to the participant’s feedback and resolve problems quickly

  • Give the participant a minimum of 24 hours’ notice if the provider has to change a scheduled appointment to provide therapy services

  • Protect the participant’s privacy and confidential information

  • Provide support in a manner consistent with all relevant laws, including the National Disability Insurance Scheme Act 2013 and rules, and the Australian Consumer Law; keep accurate records on the supports provided to the participant

  • Issue regular invoices and statements of the therapy services delivered to the participant as per the Terms of Business for Registered Providers. 

Responsibilities of the participant/participant’s representative 

The participant/participant’s representative agrees to: 

  • Inform the provider about how they wish the therapy services to be delivered to meet the participant’s needs

  • Treat the provider with courtesy and respect

  • Talk to the provider if the participant has any concerns about the therapy services being provided

  • Give the provider a minimum of 24 hours’ notice if the participant cannot make a scheduled appointment; and if the notice is not provided by then, the provider’s cancellation policy will apply

  • Give the provider the required notice if the participant needs to end the service agreement (see ‘ending this service agreement’ below for more information), and

  • Let the provider know immediately if the participant’s ndis plan is suspended or replaced by a new ndis plan or the participant stops being a participant in the ndis. 


Dietitian SJ will seek payment for their provision of therapy services in the following manner after the participant confirms satisfactory delivery.  

Payment option

Changes to this Service Agreement 

If changes to the treatment or their delivery are required, the parties agree to discuss and review this Service Agreement. The parties agree that any changes to this Service Agreement will be in writing, signed, and dated by the parties. 


Ending this Service Agreement 

Should either party wish to end this Service Agreement they must give 1 months’ notice. 

If either party seriously breaches this Service Agreement the requirement of notice will be waived. 

Feedback, complaints, and disputes 

If the participant wishes to give the provider feedback, the participant can talk to the main Practitioner or

If the participant is not happy with the provision of therapy services and wishes to make a complaint, the participant can talk to Sally Juan on 0433 201 678 or

If the participant is not satisfied or does not want to talk to this person, the participant can contact the National Disability Insurance Agency by calling 1800 800 110, visiting one of their offices in person, or visiting for further information.

Schedule of Support

Cancellation Policy 

Participant will need to provide 24 hours notice, otherwise cancellation fee of 50%  will be charged.

Agreement signatures 

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