Childcare Service Agreement Form

Agreement for Mobile Dental Services at Your Childcare Centre

Agreement Submitted Successfully!

Thank you for submitting the Childcare Service Agreement. We'll contact you within 2 business days to confirm the details and schedule your dental visit.

A copy of this agreement has been sent to your email.

Provider Details

Shlama Dental - Service Provider

Business Name: Shlama Dental
Contact Person: Ata Shaheen - Oral Health Therapist
Phone: 0452 524 832
Email: info@shlamadental.com.au
Website: www.shlamadental.com.au

Childcare Centre Details

Agreement Purpose

This Agreement confirms that Shlama Dental will provide on-site mobile dental services to children attending the above Childcare Centre.

All services are delivered only where valid written parental consent has been obtained prior to treatment.

Scope of Services

Services may include but are not limited to:

  • Dental health education
  • Oral examinations
  • Professional cleaning
  • Fluoride application
  • Fissure sealants (if needed)
  • Dental reports for parents

Responsibilities

Shlama Dental Responsibilities

  • Provide suitably qualified and insured clinicians
  • Comply with NSW Health and infection control standards
  • Maintain accurate and confidential clinical records
  • Supply all required portable dental equipment

Childcare Centre Responsibilities

  • Distribute and collect consent forms (2-3 weeks before visit)
  • Coordinate appointment scheduling with parents
  • Provide a safe and clean treatment area
  • Inform staff and parents of scheduled visits

Fees & Billing

Medicare (CDBS Eligible Children)

Provides up to $1,132 per child over 2 years (for eligible families). These students receive care at no cost.

Private Health Insurance

Full Treatment value is $159.65. We will claim directly the full treatment value - families only pay the gap, if any.

Parent/Guardian Payment

Preventive package available for $85, which includes: oral health education, exam, cleaning, fluoride, and dental report.

Important: The Childcare Centre bears no financial liability unless otherwise agreed in writing.

Safety, Insurance & Liability

Professional Standards

Shlama Dental maintains current Professional Indemnity and Public Liability Insurance. Each party agrees to act reasonably and in accordance with applicable laws and regulations while this Agreement is in force.

Our dental team are fully qualified, insured, and child-safe professionals. Staff carry photo ID and Working with Children Checks.

Privacy & Confidentiality

Information Protection

All personal and health information shall be handled in accordance with the Australian Privacy Principles and relevant health records legislation.

Written parent/guardian consent is required for all services. We protect all personal information in line with privacy laws. Consent forms should be stored at the centre and handed to our team daily.

After Our Visit

Each child receives a written Oral Care Plan. Plans are emailed to parents and the centre within one week of the dental visit.

Term & Termination

Either party may terminate this Agreement by providing 30 days written notice via email or post to the other party.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of New South Wales, Australia.

Visit Arrangements

Important: Ensure 10+ children are confirmed with consent forms, or the session may be rescheduled or cancelled.

The Centre agrees to provide a suitable, private, and hygienic space and assist with supervision during visits.

Daily Scheduled Routine

9:30 AM
Staff preparation and setup
10:00 AM
Dental education session for children
10:30 AM
Dental check-ups begin

Childcare Centre Signature

Contact Information

If you have any questions, please contact us at:

Phone: 0452 524 832

Email: info@shlamadental.com.au

Website: www.shlamadental.com.au

All information provided is confidential and secured with SSL encryption.

This agreement will be processed within 2 business days. You will receive a confirmation email with next steps.