Service Agreement Send

All of the first section should be filled out for you; you just need to provide the billing information and complete the unpopulated fields. When you submit the form, you will have all the information you need to autofill in the Service Agreement to send out.

Service Agreement Data

A form to identify the NDIS code to be used, the cost and any other customised data that needs to be added to the service agreement by the admin team

Your Name (Parent/Guardian)
Participant's Name
Mother, Father, Grandparent, Guardian etc
DD slash MM slash YYYY
Address

Billing Details REQUIRED

lCLICK HERE TO SEE OUR BILLING ITEMS AND CODES
Found in the "Peppermint Place Billing Codes.xls" file.
Add the billing item code description from the .xls.
Add the hourly rate from the billing codes xls.
If there is a second support billing category, if not, don't add them.
Found in the "Peppermint Place Billing Codes.xls" file.
Add the billing item code description from the .xls.
Add the hourly rate from the billing codes xls.
DD slash MM slash YYYY
DD slash MM slash YYYY
End of the year, or end of the NDIS plan, whichever comes first.
DD slash MM slash YYYY

Still Have Questions?

If you have questions about whether or not Peppermint Place is a good fit for your child/young adult, or regarding your NDIS package and how it could be used for one of our programs, please fill out the form and a lovely human being will contact you.

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