Service Agreement Form

Office use

Your Program
Will you have a support person help you in your program?*
A support person is someone who will help/guide you in your program.
- Yes
- No
Total program quoted (includes non-face-to-face supports)
Choose the programs you want to do:*
Note: we have included 2 hours extra time in all quotes in case your program is evening or weekend. Please see our Fees for details on how we charge and claim from the NDIS: NDIS
- Talk about Food (2-3 sessions)
- Help your Health (2-3 sessions)
- Plan your Weekly Meals & Snacks (1 session)
- Quoted amount (see notes)
Total
$ 0.00

Office use

Tick the NDIS support/s that you will claim from your NDIS plan for your program:*
- Interpret/Translate includes non F2F supports [03_090_0121_1_1]
- Social and Community Participation includes non F2F supports [09_008_0116_6_3] or [04_210_0125_6_1]
- Assistance with Daily Living only for Supported Independent Living Accommodations (SIL) [01_801_0115_1_1] or [01_020_0120_1_1]
- Assist-Travel/Transport [02_051_0108_1_1] - this is for special arrangements only.
Start Date*
Choose the beginning of the month to start your program
DD slash MM slash YYYY
End Date*
Choose the end of the month to end your program
DD slash MM slash YYYY
Notes about your program:

Office use

Your Agreements
You must read and understand our Terms of Service before signing the agreement*
Click here for the Terms of Service: Terms of Service
- Yes I agree with the Terms of Service
You agree for your NDIS supports to fund your program?*
By selecting Yes, you agree with your program, timeframe, quote, and consents for your program with Deaf Chef Ross.
- Yes
- I'm not using NDIS

Office use

Your Digital Signature
This is your digital signature to confirm this Service Agreement for your program (client OR parent/guidance if the client is under 18 years old). This is your digital signature. Please ask us if you do not understand the agreements.
Your name*
The client for the program in this service agreement OR parent/guidance if the client is under 18 years old:
First name Surname
Your email address*
TODAY date*

Day
Month
Year
Signature*
CONFIRM then SUBMIT

Office use

Your Program