Plan Management Service Agreement

Ready to start or switch to NDIS plan management in Albany with Synergy West? Complete the form below with your details and current NDIS plan information our team reviews every request within 24 hours and begins managing your funding right away.

A Plan Manager’s role is to pay providers for supports delivered under your NDIS plan. A Plan Manager will help you monitor your funds and provide financial reporting by way of sending you a monthly report, which shows details of funds spent and remaining balances in your NDIS plan.

To appoint Synergy West Plan Management as your NDIS Plan Manager, please take the time to fill out the information below.

If you are a Support Coordinator or Provider, please do not fill out this form. Instead, you can reach our team here

What Happens After I Submit This Form?

Our team reviews your details and NDIS plan information within 24 hours
We verify everything to ensure your funds are handled smoothly from day one
We begin managing payments to your providers and tracking your budget
You receive monthly reports showing spending, remaining funds, and progress

Clarification Note: If you’re a Support Coordinator or provider, please don’t fill out this form, reach our provider team directly instead via the For Providers page.

Form Role

Who is completing this form?*

I am an NDIS ParticipantI am a Parent, Nominee, Guardian or Authorised Representative of an NDIS Participant

Service Agreement Consent*

This Service Agreement is for a Participant on the National Disability Insurance Scheme (Participant), and is made for NDIS Plan Management services and supports. You nominate Synergy West Plan Management to manage funding for NDIS Supports as per the below agreement. This Service Agreement is made between Synergy West Plan Management (the Provider) and You (the Participant):

Yes, I would like Plan Management services to be provided by Synergy West Plan Management

First Name (Participant)*

Last Name (Participant) *

Postal Address

Email *

Phone *

Date of Birth *

Plan Review Date

NDIS Number *

Preferred Contact Method (select an option)*
Phone CallSMS/TextEmailPostEasy English

How Did You Hear About Us?

Social MediaGoogle SearchWord of MouthSupport Coordinator ReferralOther

Is there a Plan Nominee, or someone other than the Participant, who is responsible for the Plan and has legal authority to make decisions on behalf of the Participant? If YES, please provide details below. *

YesNo

Allow your Plan Nominee/Authorised Representative access to:

Online DashboardMonthly Statements

Do you have a Support Coordinator?*
YesNo

Please enter your Support Coordinator’s details:

Allow your Support Coordinator access to:

Online DashboardMonthly Statements

Consent to Share: By ticking the box on the sign-up page, you agree to the terms and conditions as outlined in this Service Agreement. The Participant agrees to share their NDIS plan and information with Synergy West Plan Management, as well as the Participant’s Support Coordinator, Local Area Coordinator (LAC) and NDIA Planner. If you do not understand any section of this agreement, please talk to a family member your nominee / representative / guardian or contact info@synergywest.com.au to obtain further clarity before acknowledging consent. If you wish to provide Consent to Share information with other providers or contacts, please select below:

Authorised RepresentativeAllied Health Providers (ie OT/Physio etc)

Please attach a copy of your NDIS Plan

Invoice Approvals: When we receive invoices to pay from your NDIS plan, how do you wish to review them? Please choose one of the below methods for reviewing/approving your Support Providers’ invoices:*

I wish to have two days to review and approve each invoice before it is paid. If I do not check and approve/decline the invoice during this time, the invoice will be automatically paid once the two days has passed.I wish to have all invoices paid automatically once they are received by Synergy West Plan Management. I will keep Synergy West Plan Management up to date with any changes in my expected supports and providers. I will check my monthly NDIS budget statement to ensure invoice payments are correct and I will contact Synergy West Plan Management if I have any questions or concerns.

Agreement Acknowledgements *

I am the NDIS Participant named above, or I am the Plan Nominee or legal representative of the NDIS Participant named above and I am authorised to submit this Service Request. The details I have provided above are true and correct.

I agree to Synergy West Plan Management's Terms & Conditions.
View Terms & Conditions

Your Signature

Today’s Date

Plan Management Service Agreement

What Happens After I Submit This Form?

Form Role

Service Agreement Consent*

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