Our trained professionals are here to help! Fill out this contact form and we’ll be in touch Service Agreement for Occupational Therapy Services Child's Name Carer’s Name PhoneEmail School/Teacher Welcome to Occupational Therapy Helping Children. We look forward to working with you, your child and other team members to help your child meet their goals. This service agreement provides you with a summary of our fees and essential information that will assist us to provide the best possible care for your child. Fees (in clinic and telepractice) The most common fees of Occupational Therapy Helping Children is as follows: Therapy session – 60 minutes 50 face to face/10-minute client notes $194.00 Parent Planning – telehealth session (per hour) $194.00 Consultation with parents (per hour) $194.00 School attendance (per hour) $194.00 Report writing (per hour) $194.00 Therapy Assistant (per hour) $ 86.80 Travel (50% of hourly rate) Additional Resources To be discussed with your OT I confirm that I understand and agree to the following : I am responsible for payment of my account at the conclusion of each therapy session. This will be via Eftpos at reception with our client services team or credit card for zoom or in school sessions. If payments become in arrears of over 2 sessions and I have not come to an alternative arrangement with Occupational Therapy Helping Children, I understand that my child’s therapy will be ceased. To be present for the first 5 minutes and last 5 minutes of my child’s therapy session, unless otherwise advised/agreed. I am aware of the cancelation policy that I need to notify my child’s therapist by sms prior to 3.00 pm on the day prior to therapy in order to avoid the full fee being charged. Failure to attend will also incur the full fee being charged. NDIS FundingAre you receiving NDIS funding for your child? Yes No If YES, what date is your plan approved until: How are you managing your NDIS funding : Agency Managed Plan Managed Self-Managed ConsentPlease tick the boxes you consent to below: Select All I provide consent for OTHC to work with my child and store relevant information. I provide consent for OTHC to communicate electronically, verbally and in writing with all members of my child therapy and education team. I provide consent for OTHC to take photos or video during therapy sessions that assist in the teaching of my child. This material will be forwarded to only to me, and deleted by the therapist at the end of the session. No photos or video will be shared in the public domain without my prior consent. I accept the terms of this service agreement. Parent Name SignatureDate MM slash DD slash YYYY CAPTCHACommentsThis field is for validation purposes and should be left unchanged.