Paticipant DetailPaticipant* Paticipant First Name Paticipant Last Name Paticipant Date of Birth* Paticipant RepresentationIs the NDIS Participant being represented by someone else for the purpose of this agreement?*YesNoContact DetailsEmail* Mobile*Plan ManagementHow is this Plan Managed?*Self ManagedManaged by a Plan NomineeManaged by The National Disability Insurance Agency (NDIA)Managed by a Plan Management ProviderCommencementWhen does this agreement commence?*At the start of the selected NDIS PlanTodayReviewHow often should this agreement be reviewed?*every monthevery 3 monthsevery 6 monthsevery 12 monthsNDIS IDParticipant NDIS ID*NDIS Plan DetailsNDIS Plan ID*NDIS Plan Start* NDIS Plan End* ServicesI provide psychological support, including assessment, recommendation, therapy or training, which is charged at the NDIS approved hourly rate (Currently $214.41). Reports, school observations, and communication with other specialists and/or related parties (for example school guidance officer) can also be provided at request and are priced based on the hourly rate noted before.