EPM Rehab – NDIS Service Agreement
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NDIS Service Agreement

EPM Rehab  ·  ABN 84 945 334 867

Participant
Services
Schedule
Terms
Emergency Plan
Signatures
Participant Details
Please complete all fields accurately as they will appear in your Service Agreement.
Personal Information
NDIS Plan Details
Guardian / Nominee (if applicable)
Services & Pricing
Select the service you are engaging EPM Rehab to provide. Rates are in line with the NDIS Price Guide 2026–27.
Select Your Service(s) * (select all that apply)
Session Schedule
Frequency and duration are set per service below. Fill in your preferred session day, time, and agreement dates here.
Session Location & Frequency *
For each service, select a location and set the frequency and duration of sessions.
Please select at least one service above to set locations and schedule.
Services & Pricing Summary
No services selected yet.
Note: Actual costs will depend on the number of sessions delivered and any travel charges. Your plan manager or the NDIA will be invoiced in accordance with your NDIS plan and the rates above.
Travel & Cancellation Policy
Please review EPM Rehab's travel and cancellation policies below.
Travel Charges
One-Way Travel Only. EPM Rehab charges travel costs for one-way travel to your session location only (not return). Travel is charged at $0.99 per kilometre (NDIS Price Guide rate) and is billed as a separate support item. Travel time may also be claimable where applicable under NDIS rules.
Short Notice Cancellation Policy
48-Hour Cancellation Notice Required. A short notice cancellation occurs when a participant or their representative cancels a scheduled session with less than 48 hours' notice. In this instance, EPM Rehab may claim up to 100% of the agreed support fee for the cancelled session in accordance with the NDIS Pricing Arrangements and Price Limits.
Cancellations must be made by contacting EPM Rehab directly:
📞 0466 201 743    ✉️ matt@epmrehab.com.au
Please provide as much notice as possible. Repeated short-notice cancellations may result in a review of this Service Agreement.
Acknowledge Policies *
Agreement Terms & Conditions
Please read the following terms carefully before proceeding. Scroll to review the full agreement.

1. Parties to This Agreement

This Service Agreement is made between EPM Rehab (ABN 84 945 334 867), an NDIS provider ("the Provider"), and the participant named in this document ("the Participant"). This agreement outlines the supports to be delivered and the obligations of both parties under the NDIS framework.

2. Purpose of This Agreement

The purpose of this Service Agreement is to describe the supports EPM Rehab will provide to the Participant, how those supports will be provided, and what is expected of both parties during the delivery of these supports.

3. Supports to Be Delivered

EPM Rehab will provide the supports selected in Section 2 of this agreement, in accordance with the NDIS Pricing Arrangements and Price Limits (2026–27). All supports will be delivered by qualified practitioners and/or trained support workers, and will be tailored to meet the Participant's individual goals and needs.

4. Participant Rights

Under the NDIS, the Participant has the right to:

  • Receive supports that respect their dignity and promote their independence.
  • Be treated with respect and without discrimination, abuse, neglect or exploitation.
  • Have their privacy and confidentiality maintained.
  • Provide feedback, raise concerns or make complaints without fear of consequences.
  • Have this Service Agreement reviewed at any time upon request.
  • Choose another provider if they wish to do so (see Ending This Agreement, below).

5. Provider Responsibilities

EPM Rehab will:

  • Provide supports that meet the Participant's needs and goals.
  • Communicate openly and promptly with the Participant and their representatives.
  • Maintain accurate records of supports delivered and billing submitted.
  • Provide all supports in accordance with the NDIS Practice Standards and Code of Conduct.
  • Maintain current registrations, insurances and mandatory clearances (WWCC, Police Check).
  • Notify the Participant of any changes to the agreed supports, staffing or costs as soon as practicable.

6. Participant Responsibilities

The Participant (and/or their representative) agrees to:

  • Provide EPM Rehab with accurate and complete information to deliver safe and effective supports.
  • Notify EPM Rehab of any changes to their NDIS plan, funding, health or circumstances that may affect support delivery.
  • Ensure a safe environment for support workers during home or community visits.
  • Provide at least 48 hours' notice for cancellations where possible.
  • Treat EPM Rehab staff with respect at all times.

7. Billing & NDIS Funding

EPM Rehab will claim payment for supports delivered in accordance with the NDIS Price Guide and this agreement. Claims will be submitted to the relevant funding arrangement (NDIA, plan manager, or participant directly). The Participant will not be billed for amounts exceeding their NDIS plan allocation for the relevant support category without prior written consent.

8. Privacy & Confidentiality

EPM Rehab handles all personal and health information in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. Information will only be shared with third parties (e.g. support coordinators, plan managers, treating practitioners) with the Participant's consent or as required by law. The Participant may access or request correction of their personal information at any time.

9. Report Writing & Non-Face-to-Face Supports

Where EPM Rehab prepares reports, clinical notes, care plans, or undertakes non-face-to-face work (such as liaison with other service providers, plan review preparation, or case conferences) related to the Participant's supports, these activities may be charged in accordance with the NDIS Pricing Arrangements under the relevant support item. The Participant will be advised in advance if report writing or non-face-to-face time is to be claimed against their NDIS plan.

10. Feedback & Complaints

EPM Rehab welcomes feedback and is committed to resolving concerns promptly. If you have a concern, please follow the steps below:

  1. Step 1 — Contact EPM Rehab directly: Raise your concern with Matt Williamson by phone (0466 201 743) or email (matt@epmrehab.com.au). We aim to acknowledge all concerns within 2 business days.
  2. Step 2 — Resolution: EPM Rehab will work with you to resolve the issue within 5 business days of receiving your complaint. You will receive a written response outlining the outcome.
  3. Step 3 — External escalation: If you are not satisfied with the resolution, or if you prefer to raise your concern externally, you may contact the NDIS Quality and Safeguards Commission on 1800 035 544 or at www.ndiscommission.gov.au. You can also contact the National Disability Advocacy Program for independent support.

You will not be disadvantaged in any way for raising a concern or complaint.

11. Amending This Agreement

This Service Agreement may be amended at any time by mutual written agreement between EPM Rehab and the Participant (or their representative). Either party may request a change to this agreement by providing 14 days' written notice. Any changes will be documented in a written amendment signed by both parties before taking effect. No verbal changes to this agreement are binding.

12. Ending This Agreement

Either party may end this Service Agreement by providing 14 days' written notice. EPM Rehab may end this agreement with less notice if the Participant's conduct places staff or others at risk of harm, or if there is a serious breach of this agreement. The Participant may choose a different provider at any time.

13. Review of This Agreement

This Service Agreement will be reviewed at least annually, or earlier if the Participant's NDIS plan is reviewed, if the Participant's circumstances change significantly, or at the request of either party.

14. Goods and Services Tax (GST)

Most NDIS supports are GST-exempt. Where GST applies, it will be included in the quoted rate. Pricing displayed in this agreement is inclusive of any applicable GST.

15. Applicable Law

This agreement is governed by the laws of Victoria, Australia, and the relevant provisions of the National Disability Insurance Scheme Act 2013 (Cth) and associated rules and guidelines.

Individual Emergency & Disaster Plan (IEDP)
As a registered NDIS provider, EPM Rehab is required to maintain a participant-specific emergency and disaster plan. Please complete this section to help us support you safely in an emergency.
1. Vulnerabilities & Support Needs in an Emergency
2. Medications & Essential Equipment
List any medications and/or essential equipment that must be available or taken in an emergency evacuation.
Medication / Equipment Dose / Specification Frequency / Use Storage / Notes
3. Evacuation Plan
4. Emergency Contacts
Emergency Contact 1
Emergency Contact 2
5. Additional Emergency Notes
Acknowledgements & Signatures
By signing below, both parties confirm they have read, understood and agree to this Service Agreement.
Participant—
NDIS Number—
Agreement Start—
Agreement EndOpen-ended
Service Rate Frequency · Duration Location
Participant Signature *
Participant Signature — Sign below
Draw your signature using a mouse or touch
Provider Signature
EPM Rehab Provider Signature — Sign below
Draw your signature using a mouse or touch
By submitting this form, a copy will be emailed to EPM Rehab and a downloadable PDF will be generated for your records. Please keep a copy for your own reference.
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