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Goal Coach - Service Agreement, Consent, and Schedule of Supports
GOAL COACH SERVICES NDIS SERVICE AGREEMENT
The purpose of this agreement is to ensure you and your Provider have an agreed set of expectations as to how your services will be delivered. For more information, ask your service Provider for a copy of their Service Delivery Model, which also outlines the participants' rights and what each party’s responsibilities and obligations are, and how to resolve any issues should they arise.
People Making this Service Agreement
Participant (Client)
Name
(Required)
NDIS Number
(Required)
NDIS Plan Dates
Start Date
(Required)
DD slash MM slash YYYY
End Date
(Required)
DD slash MM slash YYYY
Phone Number:
(Required)
Address:
(Required)
Date of Birth
(Required)
DD slash MM slash YYYY
Email
(Required)
Alternate Contact Person Name:
Alternate Contact Person Number:
Participant Representative
Representative Name
Representative Address
Representative Phone Number
Representative Email
Invoicing Details
Agency-Managed | Self-Managed | Plan- Managed
Agency-Managed
Self-Managed
Plan- Managed
Name of the Provider Who Will Pay My Invoice
Phone Number
Email to Send Invoices to
Other Details:
Service Provider
Name of Provider:
Goal Coach Services Pty Ltd
Name of Business:
Goal Coach
NDIS Provider Number:
4050130162
ABN:
99 654 609 006
Phone Number:
1300 190 377
Email:
hello@goalcoach.com.au
Services and Supports to be Provided
The Service Provider (also referred to in this Agreement as “Provider” or “Our”) agrees to provide the Participant (also referred to as “the Participant” or “you” or “your” in this Service Agreement) with Goal Coach and Supports (Services) for the duration as per your agreed Support Plan which will be completed as part of the initial assessment.
The Supports and their prices are outlined in the Support Plan, which identifies your goals and the amount you agreed to for the duration as per your agreed Support Plan which will be completed as part of the initial assessment.
Additional expenses (i.e., things that are not included as part of a Participant’s NDIS supports) are the responsibility of the Participant and the Participant Representative (if named) and are not included in the cost of the Supports.
Responsibilities of the Provider
The Provider agrees to:
Consult with the participant in the development of their Support Plan
Review the provision of support at regular intervals with the participant
Once agreed, provide supports that meet the Participant’s needs at the Participant’s preferred location and times whenever possible
Communicate openly and honestly in a timely manner
Treat the Participant with courtesy and respect
Protect the Participant’s privacy and confidential information as per the Privacy Act 1988 (And provide a copy of the Provider’s Privacy and Information Management Policy if requested)
Give the Participant information about managing any complaints or disagreements and details of the Provider’s cancellation policy
Listen to the participants’ feedback and resolve problems quickly
Give the Participant a minimum of 1 business day’s notice if the Provider has to change a scheduled appointment to provide support
Provide support in a manner consistent with all relevant laws, including the National Disability Insurance Scheme Act and Rules, and the Australian Consumer Law
Keep accurate records on the supports provided to the Participant
Issue weekly invoices for the provision of support delivered to the Participant
Give the Participant the required notice if the Provider needs to end the Service Agreement (see Ending this Service Agreement below)
Continually inform the Participant of possible risks and benefits associated with achieving their goals
Investigate any incidents that occur and follow
the NDIS (Incident Management and Reportable Incidents) Rules 2018
This includes involving the Participant in the investigation and determining actions/outcomes. A copy of the Provider’s Incident Management Policy can be provided if requested.
Responsibilities of the Participant and/or their Representative
The Participant and the Participant’s Representative (if named in this Agreement) agree to:
Be involved in the development of your Support Plan, informing the Provider how you wish your Services to be delivered
Provide accurate information
Inform your Provider if you are receiving other services or supports.
Treat the Provider with courtesy, respect, and dignity
Provide a safe environment for the Provider to work
Talk to the Provider if you have any concerns about the supports being provided
Give the Provider a minimum of one full business day’s notice if you cannot make a scheduled appointment; if the notice is not provided by then, the Provider’s Cancellation Policy will apply (see below)
Ensure there are appropriate funds available for claiming services that have been booked and provided. If your Provider is unable to make a claim to NDIA for the provision of a service due to insufficient funds, you are responsible for payment
Give the Provider the required notice if you need to end the Service Agreement (see Ending this Service Agreement below)
Let the Provider know immediately if your NDIS plan is suspended or replaced by a new NDIS plan, or if you stop being a Participant in the NDIS.
Give the Provider feedback or lodge a complaint if you are dissatisfied with the service or the way it is delivered (See Complaint Policy below)
Discuss your concerns with the possible risks associated with achieving your Support Plan
Request a copy of any of our Policies if further information is required
Pay our Costs (see below). Where a Participant and a Participant Representative are named in this Agreement, they are jointly and severally liable for our Costs.
Costs
The cost of our Services is in line with the NDIS Pricing Arrangements and Price Limits 2025-26 and the NDIS Support Catalogue 2025-26, in which the hourly rate for:
Support Type
Hourly Rate (as of the current NDIS Price Guide)
NDIS Line Item Code
Notes
Occupational Therapy
$193.99
15_617_0128_1_3
Price subject to change
Psychosocial Recovery Coaching
$105.43
07_101_0106_6_3
Price subject to change
Support Coordination (Level 2)
$100.14
07_002_0106_8_3
Price subject to change
Should pricing changes occur, these will be reflected in future invoices in line with the NDIS price schedule
Provider Travel – is not applicable for Telehealth services
Non-face-to-face costs may include phone and email communication with participants, support people and other professionals involved in the participant’s NDIS program, recording of file notes (required by law), researching supports, assistive tech products and writing assessment reports.
Payments
The Provider will seek payment of its Costs directly through to the plan manager, agency, or self-managed for payment to the email address.
Payment is required no later than 7 days after submission of invoices. No reports will be released until full payment has been received. Should delays in payments occur, ongoing service provision work may be postponed/put on hold until payment has been received.
Insufficient Funding
If the Funding set out in this Service Agreement is not available or accessible, or has been mismanaged or exhausted, and or requires an unscheduled plan review, the Services may be suspended, and the Provider will require payment of all outstanding accounts by the Participant and the Participant Representative.
Support Plan
Each Participant will have a Support Plan outlining their goals, the Services to be delivered to achieve the goals and a review date.
The Support Plan also provides a breakdown of costs. This plan will be developed in consultation with the Participant and pertinent others, who may include a guardian, family member, appointed decision-maker, advocate, and Provider.
Cancellation Policy
The Provider requires one clear business day’s notice for a cancellation; otherwise, 100% of your fee will be charged. The NDIS cancellation policy can be found in the
NDIS Pricing Arrangements and Price Limits 2025-26
Ending this Service Agreement
The Participant’s NDIS plan is expected to remain in effect during the period the Services are provided; and the Participant / Participant’s Representative will immediately notify the Provider if the Participant’s NDIS Plan is replaced by a new plan or the Participant stops being a Participant in the NDIS.
Should a Party wish to end this Service Agreement, they must give 14 days ’notice.
If a Party seriously breaches this Service Agreement, the requirement of notice will be waived.
Complaints Policy
If the Participant wishes to give the Provider feedback or wishes to make a complaint, the Participant can contact the Provider directly, via phone (1300 190 377) or email (
hello@goalcoach.com.au
).
If the Participant would prefer to speak about their concerns with someone other than the Provider, they can contact the NDIS Quality & Safeguards Commission on 1800 035 544, or go to their website to lodge an online complaint
https://www.ndiscommission.
gov.au/about/complaints
.
Anonymous and confidential feedback can be provided to Goal Coach via (
feedback@goalcoach.com.au
|
https://goalcoach.com.au/
anonymous-feedback/
)
For further information on Complaints Management, ask to see our Complaints Management Policy.
Emergency and Disaster Planning
Important Notice:
Goal Coach is a telehealth-only service provider and does not deliver day-to-day personal care or emergency response services. In the event of any immediate or life-threatening emergency, participants must call Emergency Services (000) or contact their nominated emergency contact.
Client Information
Participant Name
Living Situation
Service Delivery: Telehealth
Weekly
Fortnightly
Monthly
Daily
Support Type
Support Coordination
Recovery Coaching
Support Coordination and Recovery Coaching
Goal Coach services are delivered exclusively via telehealth, and we do not provide face-to-face or 24/7 support. While our team is committed to providing ongoing support during scheduled sessions, we do not offer crisis or emergency response services. Our responsibilities during an emergency are limited to the scope of our telehealth support model.
In Case of Emergency
Please get in touch with the relevant emergency services and support:
Fire, Police, Ambulance: 000
State Emergency Services (SES): 132 500 (for floods, cyclones, storms, structural damage)
Flood or Bushfire Warnings:
https://www.bom.gov.au/
or local council website
COVID-19 and Pandemic Alerts:
https://www.health.gov.au/
Lifeline (Mental Health Crisis): 13 11 14
Next of Kin / Emergency Contact
Name
Phone
Treating Health Professional (GP / Psychologist / Psychiatrist)
Contact Details
Provider Responsibilities During an Emergency or Disaster
Goal Coach will attempt to maintain telehealth support wherever possible during disasters such as:
Floods, bushfires, storms, or other natural events
Pandemics or infectious disease outbreaks
Power outages or communication disruptions
Personal emergencies impacting the participant (e.g., hospitalisation, mental health crisis)
Our team will:
Conduct wellbeing check-ins via phone or video
Reschedule missed sessions or reallocate to a secondary coach or coordinator
Offer practical guidance in accessing formal supports (e.g., emergency housing, food relief, community services)
If Goal Coach staff experience an emergency or disaster:
We will notify participants of service disruptions as soon as practicable
We may request a copy of the participant’s personal emergency plan to help maintain continuity of care
Support may be reallocated temporarily to an alternative team member
Additional Emergency Preparedness Steps
To help prepare for emergencies, we recommend the following:
Register with your local council or emergency alert system, especially if you live in a disaster-prone area (e.g., flood or bushfire zones). If needed, we can assist you with this process.
Consider registering with your local police station if you live alone or have additional vulnerabilities.
Keep a printed and accessible list of:
Emergency contacts
Medications and critical health information
Essential supplies (e.g., food, water, torch, batteries)
Notify your Recovery Coach or Support Coordinator of:
Any changes in your address, phone number, or emergency contact
Any mobility, communication, or medical needs that may impact your ability to respond to an emergency
Contacting Goal Coach in an Emergency
If you are affected by an emergency and need to speak with us, please contact:
Goal Coach Administration
📞 1300 190 377
📧 hello@goalcoach.com.au
We will assess the situation and provide support within the limits of our service model.
Privacy and Information Policy
At Goal Coach services, we strive to maintain your privacy and comply with the Privacy Act 1988 and the Privacy Amendment Act 2012 to protect the privacy of individuals' personal information.
Please ask for a copy of the Occupational Therapy Group’s Privacy and Information Policy for more information.
Participant | Representative
Date
(Required)
DD slash MM slash YYYY
Name
(Required)
Signature
(Required)
Goal Coach Services Pty Ltd
Date
DD slash MM slash YYYY
Provider Name
Provider Name Signature
Position
CONSENT AND AGREEMENT
I am the Participant or an authorised representative of the Participant with the authority to sign this Agreement on behalf of the Participant
If a Participant’s Representative is named in this Agreement, I am authorised to sign this Agreement on behalf of the Participant’s Representative
I understand and agree to the terms and conditions of this Service Agreement (on behalf of any Party I am acting for)
I give my consent to commence the Services outlined in my Support Plan
I consent to my Provider sharing information with my other Service Providers, excluding (Enter names if applicable.)
I understand that my Provider may be required to share information without my consent only when legally mandated.
I consent to my Provider taking photographs for the purpose of providing their support and inserting them in reports only if required.
I consent to participate in a Participant satisfaction survey, and I understand I may be contacted by a third party to complete a questionnaire.
I consent to participating in an NDIS quality management activity, which may include being contacted by a third- party auditor.
I declare that the Funding set out in this Agreement in its entirety is available for the Provider to commence providing the Services as set out in this Agreement.
Participant | Representative
Date
(Required)
MM slash DD slash YYYY
Name
(Required)
Signature
(Required)
Goal Coach Services Pty Ltd
Date
MM slash DD slash YYYY
Provider Name
Provider Name Signature
Position
SCHEDULE OF SUPPORTS
Participant Name
Participant NDIS Number
Start Date
DD slash MM slash YYYY
End Date
DD slash MM slash YYYY
Part A:
Support Item ( Support Category / Description of Support )
Capacity Building - 07_101_0106_6_3 Psychosocial Recovery Coaching (Weekday Daytime)
Capacity Building - 07_002_0106_8_3 Support Coordination Level 2: Coordination of Supports (Weekday Daytime)
Capacity Building: Improved Daily Living Skills - 15_617_0128_1_3 Assessment Recommendation Therapy or Training - Occupational Therapist (Weekday Daytime)
Cost per Unit
Psychosocial Recovery Coaching - $105.43
Unit of Measure ( hours )
Notes
Cost per Unit
Support Coordination Level 2 - $100.14
Unit of Measure ( hours )
Notes
Cost per Unit
Assessment Recommendation Therapy or Training - $193.99
Unit of Measure ( hours )
Notes
Goal Coach Services will adjust its prices periodically in line with the NDIS pricing arrangements, which are available on the NDIS website
http://www.ndis.gov.au
Charges on this NDIS agreement are based on the current NDIS Pricing Arrangements and Price Limits 2025-26
Part B:
Service booking (if NDIA/Agency Managed)
Support Category
07_101_0106_6_3 Psychosocial Recovery Coaching (Weekday Daytime)
Funding Amount
Start Plan Date
DD slash MM slash YYYY
End Plan Date
DD slash MM slash YYYY
Booking Number
Support Category
15_617_0128_1_3 Assessment Recommendation Therapy or Training - Occupational Therapist (Weekday Daytime)
Funding Amount
Start Plan Date
DD slash MM slash YYYY
End Plan Date
DD slash MM slash YYYY
Booking Number
Support Category
07_002_0106_8_3 Support Coordination Level 2: Coordination of Supports (Weekday Daytime)
Funding Amount
Start Plan Date
DD slash MM slash YYYY
End Plan Date
DD slash MM slash YYYY
Booking Number
Declaration
I declare that this schedule of support has been discussed and agreed to with the povider.
If applicable, I declare that this service booking has been discussed and agreed to with Goal Coach, making this Service Booking on the NDIS portal.
Participant | Representative
Date
(Required)
DD slash MM slash YYYY
Name
(Required)
Signature
(Required)
Goal Coach Services Pty Ltd
Date
DD slash MM slash YYYY
Provider Name
Provider Name Signature
Position
Thank You For Your Submission
