Request a Seat Me Safely Disability and Mobility Consultation

1About

2Service Agreement and T&Cs

3Your Details

4Funding

5Client

6Vehicle

Thank you for contacting Kidsafe Victoria.

In this form we refer to 'client' as the person requiring consultation or requiring mobility support. So that we can reduce wait times, we appreciate you taking the time to answer the questions and giving contact details of all the parties concerned.

If you have difficulties completing the form, please contact us at mobility@kidsafevic.com.au.

Consent*

Service Agreement & Fees

In-person Consultation Fees | Seating Solutions

1. In-person consultation fee is $193.00 per hour or part thereof within the Melbourne Metro Area.

2. For locations outside of the Melbourne Metro area, travel time will be added to the consultation fee at a rate of $193 per hour or part thereof.

3. Service bookings are required before consultation appointments can be confirmed.

4. An invoice for consultations will be issued at completion of the appointment and payable within 14 days

5. Consultation fee/s are payable by client even if funding is not approved/ available and regardless of the quotation being accepted.

6. After consultation, a quote for delivery, installation, supply of agreed products e.g. child car restraint, modifications, harnesses or accessories will accompany the consultation invoice.

7. Products are not supplied, delivered or installed until payment has been received for product and any consultations.

8. A follow-up online consultation are available to ensure the product is working and being fitted properly. Consultations are conducted via Zoom and are $85 for 30min.

Terms & Conditions

These Terms and Conditions apply to quotes / invoices supplied for consultation services by Kidsafe VIC at an agreed location.

We use the following term:

“Kidsafe VIC” means Kidsafe Victoria Inc.

“Client”, “you”, or “your” means your service / organisation or individual (parent / carer)

Quotes

Quotes are estimates based upon the products / modifications / accessories trialed by the client and or other party. Quotes are subject to change in the event of product price increases.

Quotes are only valid for 60 days from the date of issue.

Venue/location and workplace safety

All parties are required to ensure that the inspection site has been assessed as suitable for Kidsafe VIC staff to provide service .

Code of Conduct

Requires workers and providers who deliver NDIS supports to:

Respect for individual rights to freedom of expression, self-determination, and decision-making in accordance with relevant laws and conventions.

Respect the privacy of people with disability.
Provide support and services in a safe and competent manner with care and skill.

Act with integrity, honesty, and transparency
Promptly take steps to raise and act on concerns about matters that might have an impact on the quality and safety of supports provided to people with disability.

Take all reasonable steps to prevent and respond to all forms of violence, exploitation, neglect, and abuse of people with disability.

Take all reasonable steps to prevent and respond to sexual misconduct.

Product Availability

Kidsafe VIC does not stock large quantities of products. Due to global shipping delays, expect extended delivery times for any product not in stock.

Completion of service agreement

The service agreement will cease once all approved products have been supplied and installed by Kidsafe VIC, or Kidsafe VIC has been notified by parties involved they no longer wish to proceed. At this stage any applicable consultation fee/s must be paid in full.

Re-trial / 2nd consultations:

Fees for subsequent consultations are applicable as per our service agreement.

Cancellation policy

At our discretion we may invoice for any work or expenses if any consultation is cancelled within 12 hours of the confirmed date and time of the booked service or not attended.

Product/ service satisfaction

If you or the client have any concerns regarding a service or product provided by Kidsafe VIC please contact Kidsafe VIC directly on 03 9036 2306 or email mobility@kidsafevic.com.au

Product warranties will apply and it is the client’s responsibility to ensure warranty terms and conditions have been met. Kidsafe Qld is not responsible for any product/s that are damaged due to misuse and the warranty is voided.

Alternatively, contact National Disability Insurance Scheme Quality and Safeguards Commission www.ndiscommission.gov.au/about/complaints

Confidentiality

It is agreed that employees of Kidsafe VIC shall not at any time either during the consultation or thereafter, divulge any confidential information about the client to anyone whatsoever without the client’s consent in writing.

Trial Products

Policies and procedures are enforced to ensure the security of our equipment. By agreeing to hire Kidsafe VIC equipment and products, you agree to follow the procedures, terms and conditions.

1) The customer will accept full responsibility of the trial equipment for any damage, loss or disfigurement sustained while in your possession.

2) The customer accepts that the costs of any required repairs or replacement for the equipment will be borne solely by the customer.

3) The customer is deemed to be in possession of the product from the point in which they receive the equipment. The equipment will be deemed to have been returned when the equipment has been safely returned to the Kidsafe VIC premises.

4) The customer is responsible for the return of the equipment by the agreed due date. A late fee will be charged on a daily basis for any late returns. Merely shipping out the product prior to the agreed due date will not be accepted, and the customer must ensure the product is returned on or before the due date.

I agree to the privacy policy and terms

Requested Service*

In-person consultation

Online / virtual consultation

Purchase with no consultation

Has the client had a consultation with us before?*

Yes

Unsure

Your Details

As the person completing the form, what is your relationship to the 'client'?*

Parent / Carer

Guardian

Health Professional

Your Name*

First Last

Your Email*

Your Phone*

Your Address*

Street Address Address Line 2 Suburb State Postcode

Parent / Carer Details

Parent / Carer Name*

First Last

Parent / Carer Email*

Parent / Carer Phone*

Parent / Carer Residential Address*

Street Address Address Line 2 City State ZIP / Postal Code

Allied Health Details

Allied Health Company*

Allied Health Contact*

First Last

Allied Health Email*

Allied Health Phone*

Allied Health Address*

Street Address Address Line 2 City State ZIP / Postal Code

Funding Details

NDIS Client Number*

NDIS Plan End Date (if applicable)

NDIS Funding*

Self Funded

Plan Manager

Agency Managed

Other

Please provide details of your NDIS Funding:*

Send Quotes / Invoices To:*

Parent / Carer

Allied Health

Plan Manager

Agency

Billing Company*

Billing Contact*

First Last

Billing Email*

Billing Phone*

Billing Address*

Street Address Address Line 2 City State ZIP / Postal Code

Client Details

Client's Name*

First Last

Client's Date of Birth*

Client's Residential Address*

Street Address Address Line 2 Suburb State Postcode

Client Measurements

So that we can select the right products to suit the client's needs, we need to know more about their physical size. We understand that taking the below measurements may be difficult, and approximate measurements are acceptable.

Client's Overall Height (cm)*

Client's Torso Height (cm)*

Client's Chest Circumference (cm)*

Client's Chest Width (cm)*

Client's Waist Circumference (cm)*

Client's Weight (kg)*

Client's Medical Conditions

We understand that it can be complex to specify a medical condition and that there can be multiple factors. The below information is just to give us a snapshot, and we will gather all information during the consultation.

Please specify the client's medical conditions:*

Cerebral Palsy

Autism

Epilepsy

Intellectual Impairment

Sensory Processing Difficulties

Genetic Syndrome

Quadriplegia / Paraplegia

Hypotonia

Other

Please specify the client's condition:*

Request a 'Seat Me Safely' Consultation

Thank you for contacting Kidsafe Victoria.

Your Details

Parent / Carer Details

Allied Health Details

Funding Details

Client Details

Client Measurements

Client's Medical Conditions