NDIS Services NDIS Services Please enable JavaScript in your browser to complete this form. NDIS Service Agreement and Schedule of Support NDIS Service Agreement The Participant Full Name Phone Mobile Email Address Alternative Contact Person (Name & Number) Advocate (if applicable) Emergency Contact Person (1) Agreement Details Participant’s NDIS Number Date of Birth Start Date End Date Scope This Service Agreement is made against the National Disability Insurance Scheme (NDIS) rules and goals. It ensures that the participant and provider have an agreed expectation of the supports in line with the NDIS Plan. Service and Support Schedule Agreed services and supports between the Participant and the Provider are documented in the Support Plan document. Schedule of Supports Support Purpose & Category Support Item & Number Description Unit of Service Number of Units Price per Unit Total Payment Info Comments Agreement Signatures Participant or Legal Guardian Signature Name Date Provider Representative Signature Name Date Submit Reset Submit
