Private Service Agreement

A Service Agreement can be made between a Client or their Authorised Representative (e.g. a parent, guardian or other nominated person) and a provider. 

In this Service Agreement, the term 'Party' or 'Parties' refers to Alssa Terlich OT (ATOT) and the Client / Client's Authorised Representative who is making this Agreement.

The Person that is Authorised to sign this Service Agreement is:

Your information is collected to:

• Assess if our services meet your needs;

• Develop a personalized care plan;

• Create resources and supports;

• Share relevant information with support staff and other providers for comprehensive planning.

Your personal information is protected under the Privacy Amendment (Enhancing Privacy Protection) Act 2012 and the Privacy Act 1988.

Collection and Use of Personal Information

• To provide and manage services;

• To report to funding bodies like Medicare and NDIS;

• For therapeutic purposes (photos and videos);

• To respond to feedback and queries.
  

Your information will not be disclosed for secondary purposes unless:

• You consent;

• It is related to the primary purpose and you would reasonably expect it;

• It is required by law or a court order;

• It is necessary to prevent a serious threat to life, health, or safety;

• There is suspected unlawful activity or serious misconduct;

• It is needed to help locate a missing person.
  

Authorisation

The Client / Client's Representative give authority for ATOT; to collect, store, use and disclose personal and sensitive information, including health records, for the primary purpose of service provision and directly related needs under the Privacy Amendment (Enhancing Privacy Protection) Act 2012 (Cth) whilst the Client remains using the services of this Organisation.  The Client / Client's Representative is aware that recorded material in audio and/or visual format and outline can be shared without consent if required by law, however, this will be communicated directly to the Client / Client's Representative if this were to occur.

If my circumstances change, the Client / Client's Representative agree to notify ATOT as soon as practicable.

Media

ATOT occasionally utilises AI-powered software within our video conferencing and telehealth platforms to capture key details from our discussions, including treatment plans, progress updates, and outcomes.

This technology ensures accurate, real-time documentation of our conversations, allowing us to focus more on the Client and less on manual note-taking. It enhances our ability to provide efficient, high-quality care.

The Client / Client's Representative consent is essential for us to use this technology. ATOT will ask for consent in each instance of using AI-powered software in the Client's care.

The sole purpose of this AI software is to improve your healthcare experience by making our sessions more productive while maintaining clear and accurate records.

Photos and videos may be taken to assist with the delivery of services. This media will not be published outside of documents and resources we create for the Client. Rest assured that the Client's personal information will be handled securely and in full compliance with the Privacy Amendment (Enhancing Privacy Protection) Act 2012, and the Privacy Act 1988. Please be aware that recorded material in audio and/or visual format and outline can be shared without consent if required by law, however, this will be communicated directly to the Client / Client's Representative if this were to occur.

Please note that the Therapist nominated above is available to discuss and explain any aspects of this Service Agreement.

Price and Payment Information:

The hourly rate, travel rates and guidelines for services included (including cancellation policy) will be subject to change, in accordance to changes each financial year.  The fees are:

Occupational Therapy: $213.99 per hour plus $213.99 per hour for any associated therapist travel 

A non-labour travel fee of $0.97 per km may be charged, and is separate to the funding hours quoted 

If any ATOT Therapist arrives to a confirmed appointment, and the Client declines service, is not present or does not show up after contact attempts, then both non-attendance of the appointment and any relevant travel will be charged.

Type of Support:

• Clinical assessment and treatment

• Clinically relevant communications including phone calls / written programs / communication with other health professionals / progress notes (any task that takes more than 6 minutes will be invoiced)

• Assessment analysis and interpretation and resource development

• Attendance at team meetings / case conferences

• Assessment and trial of equipment as required

• Any reports, forms, or letters as required by the Client / Client's Representative

• Cancellation charges for late notice or no show appointments

• Travel to and from appointments
  
  

Travel

Travel to and from appointments is bilable at an hourly price limit in the following increments:

• Up to 30 minutes for MM1-3- areas and;

• Up to 60 minutes for MM4-5 remote areas.
  

If the Client is the only or last appointment of the day, 30 minutes to and from appointment may be charged.

Alissa Terlich ABN: 37 204 681 288

Payment is due by Electronic Funds Transfer within 7 days of invoicing.

Alissa Terlich OT agrees to:

• Be polite, friendly, transparent and treat the Client and their care team with respect at all times.

• Communicate openly and honestly.

• Work with the Client / Client's Representative to review their progress and support them to make changes in approach if needed.

• Explain things clearly so the Client / Client's Representative understands every step of the processes.

• Include the Client / Client's Representative in all decisions about the Client's supports.

• Listen to your feedback and act quickly upon any complaints the Client or their care team report to us.

• Promote safe work practices that protect all Clients and ATOT team members.

• Provide Therapy services as per this agreement and in accordance with NDIA procedures.

• Reserve the right to change prices within the agreed period.

• Store Client information carefully and maintain their privacy.
  
  

The Client / Client's Representative agrees to:

• Be respectful and honest with ATOT staff.

• Notify ATOT about any changes they wish to be made to this Service Agreement.

• Provide at least 48 hours notice if you wish to cancel a booked service; and if the notice is not provided by then, the ATOT's cancellation policy will apply.

• Provide at least 1 month's notice if you wish to terminate ATOT services.  

• Pay invoices by the due date.

At ATOT we value consistent and high quality intervention. If the Client needs to cancel an appointment it is recommended it occur 48 hours before the appointment to avoid a cancellation fee.

If you contact ATOT without 48 hours notice prior to your appointment or on the day of your appointment, you will be  charged for the full amount of the scheduled service fee, including travel (or part thereof) already undertaken.

ATOT at its sole discretion may waive the cancellation fee pertaining to certain situations where the notice period was unavoidable such as hospitalisation.

Should an ATOT therapist arrive at the Client's scheduled appointment and the Client / Client's Representative are not at home or at the location of the appointment with no prior notice, or declines service, or does not attend the appointment after several contact attempts, the scheduled session will be charged at 100% of the scheduled fee for that session and any corresponding travel. Where ATOT cancels a support due to operational reasons, the service will be rescheduled at no penalty to either party.

Where multiple cancellations or no shows occur in a 12-month period, ATOT will initiate contact with the Client's Representative and their support network to establish the supports we are providing are best suited to the family dynamics and the needs of the Client.

Outstanding fees need to be paid prior to further services being provided.  If fees are not paid, ATOT may contact the following (where applicable) to recover the outstanding debt: a Debt collector.

We will strive to ensure that your experience with ATOT is a positive one, however in any instance where you are unhappy with our service, feel free to discuss this with us as soon as possible.  Please be assured that we welcome all feedback and will endeavour to resolve any issues or concerns in a timely manner.

Please contact us:

Email: hello@alissaterlichot.com

Phone/Text message: 0419 808 673

If changes to the supports 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.

Should either Party wish to end this Service Agreement they must give 1 month's notice. If either Party seriously breaches this Service Agreement the requirement of notice will be waived. 

We will then send back an updated amended copy of this Service Agreement back to you for consent and signature.

By signing this Agreement, you agree to all of the information included.

Please note, if we do not receive back a signed copy of this Agreement and the Client continues to attend appointments after receiving, it is implied the Client / Client's Authorised Representative have accpeted the terms within this Agreement.

I have read & understood this Service Agreement and understand each item listed within.  I understand ATOT will be engaged to provide services that it is entitled to receive payment in return.

I confirm that authority has been delegated to me the undersigned, to represent the Client and execute this Agreement as the Client's Authorised Representative.