Dr. Boland has a general psychotherapy practice treating children, adolescents and adults . He has been in private practice since 1988 and specializes in Cognitive Behavioral Therapy (CBT) and Behavioral Family Psychotherapy.
Dr. Boland graduated Summa Cum Laude (top 2%) from the University of Northern Colorado in 1981 and received his Ph.D. in Clinical Psychology from the University of South Carolina in 1987. He completed his psychology internship at the Medical College of Georgia and his postdoctoral supervision at G. Werber Bryan Psychiatric Hospital in Columbia, SC. He is certified by the Board of Governors of the American Psychological Association College of Professional Psychology in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders.
Dr. Boland has been married to Dr. Janet U. Boland since 1986. Dr. Janet Boland is also a licensed psychologist. They have two adult children. Jonathan was on the Swim/Dive team and graduated with five school records, including the school record for the fastest 100 backstroke and the fastest 100 butterfly in the history of the University of South Carolina Swim program. He also had three school records in relays and went to the Olympic Trials in the summer of 2016. He graduated Summa Cum Laude in pre-med from the Honors College at the University of South Carolina (USC) in May of 2017 . He currently is a medical student at the Medical University of South Carolina medical school in Charleston. Katherine graduated from MUSC medical school and completed her residency in Internal Medicine at Tulane. The Bolands enjoy travel and sports.
Dr. Doris Páez has over 30 years of experience with psychological and psychoeducational services for children, adolescents, young adults, adults and families. She is fluent in Spanish and holds unique credentials as a trained bilingual psychologist. Dr. Páez also counts with extensive work experiences in higher education, government, non-profit and healthcare sectors. Her credentials include a B.A (Psychology), M.A (Behavioral Sciences & Education) and Ed.S. (School Psychology) from the University of South Florida, as well as a Ph.D. (Psychology/School Psychology) from the University of Florida. She completed a pre-doctoral psychology internship in rehabilitation psychology and post-doctoral psychology residencies in emotional disorders and developmental pediatrics. Dr. Páez is a graduate of the prestigious Liberty Fellowship program, a two-year, Aspen Institute inspired training for leaders for the state of South Carolina. She is a licensed South Carolina psychologist since 2000 and a nationally certified school psychologist since 1987. Dr. Paez is the author of over 200 publications and has presented at over 800 local, state and national events, including conference keynote and commencement addresses. She is a recipient of several service awards, including the National Association of School Psychologists’ Presidential Award and the City of Winston-Salem’s (North Carolina) Outstanding Women Leaders Award. She is the mother of two adult children who will be attending South Carolina State University and Florida State University in the fall of 2019.
Dr. Oluwatoyin Okei is a Licensed Professional Counselor Associate of the South Carolina State Board Examiners for Counselors, Therapists and Psycho-Educational Specialists. Dr. Okei is also a Nationally Certified Counselor. Dr. Okei is focused in the practice of treating children, adolescents and adults using Cognitive Behavioral Therapy and Reflective Therapy in Individual, Couples and Behavioral Family Therapy.
She obtained her Doctorate in Counselor Education from the University of South Carolina in 2017 from the Counselor Education and Supervision program. She received a Master of Science in Education degree with a major in Counselor Education from the University of Wisconsin, Oshkosh in 2003. Dr, Okei works part time as an Adjunct Faculty at Webster University, Columbia Metropolitan campus where she was awarded the Faculty of the Year in June 2019. Dr. Okei is married with two children.
Keva, our office manager, will be happy to take your call and schedule you an appointment with one of our psychologists.
Dr. Joseph Boland & Associates 1024 Wildewood Centre Drive, Suite A Columbia, SC 29229US
You can leave a confidential message if after hours or we are not able to answer your call. We will get back to you as soon as we can!
We provide evaluation and treatment for ADD and AD/HD, Mood Disorders, Anger Management, Child/Adolescent Behavioral Problems, Conduct problems, Family transitions (step-family integration), Alcohol, Drug, Gambling & other addictions, Anxiety, Panic Attacks, OCD, Depression, Stress, Eating Disorders, Weight loss, Grief Counseling, Individual Counseling, Couples/Marital Counseling, and Intimacy Issues. We provided psychoeducational for School under achievement, low motivation and learning disabilities and psychological testing for children, adolescents and adults for emotional and mental health issues.
Patients typically start with a diagnostic interview. Patients come to us for treatment because we do much more than just listen to their problems. We work hard to be compassionate, yet firm, an approach that has helped thousands of patients lead more happy and productive lives. We always try to provide clear, precise feedback and instructions on how to correct problems. Most patients choose to audiotape their sessions so they can listen to the sessions again at home and take notes. Skills are developed by completing exercises between sessions. We do not believe in endless therapy that costs you a fortune. Our educational and skills building approach teaches patients the skills they need so they quickly no longer need psychotherapy. With child behavioral problems, AD/HD, and school problems, we teach parents specifically how to correct the behavior. Dr. Boland specializes in teaching self-discipline and self-control to impulsive children. Parents learn how to make their children talk respectfully, follow directions, be responsible, and be honest. With couples, Dr. Boland teaches communication skills and effective conflict resolutions skills. Improving intimacy is a common goal. Both partners are seen as part of the solution and given suggestions for improving the relationship.
Call Dr. Boland & Associates Now - (803) 781-4265
Depression, fear, and anxiety are some of the most common and uncomfortable emotions that we can experience at some point in our lives. Through counseling and treatment, we are able to help you recover motivation, perspective, and joy that you once had in your life.
Many individuals can experience symptoms associated with painful and traumatic circumstances. Anxiety, fear, and hopelessness are a few emotions that can linger post traumatic events. We can help you overcome these symptoms and guide you through the process of grief and healing.
Relationship counseling can be beneficial to couples who are looking to strengthen their emotional connection, in all stages of their relationship. Therapy sessions are held with both couples and is a supportive place to discuss issues and solutions to better strengthen your relationship.
***** CBT was great! Dr. Boland was Great! No more depression, panic or anxiety and no more medication! Bobby C. Columbia SC (Healthgrades)
I was In a really bad marriage and Dr. Boland really helped me cope with the divorce process. He was nonjudgmental and supportive, did not push religion and helped me become emotionally strong!
Dr. Boland gives sound advice. If you want the truth, good or bad, go see him. If you want someone with no opinion or just tells you what you want to hear, go somewhere else. Some people do not want to hear what they are doing wrong. Dr. Boland is all about personal responsibility!
Dr. Boland is the discipline guru of South Carolina. He will teach you how to effectively discipline your children so they listen to directions the first time without attitude, talk respectfully to others, act responsibly and follow house and school rules. My children are so much better. Go see him.
Doc is bloody brilliant! Every question I had, he had a well thought out, logical, impressive answer. He has obviously been a psychologist for long time and knows all the pitfalls and solutions. He is very knowledgeable and competent. I will definitely go back to him in the future if I ever need to again. He had me audio record his feedback so I could take it home and listen again and take notes which was quite helpful. Most doctors are too insecure to let you record them. He said he likes to do it with all his patients as his goal is to work himself out of a job by teaching me how to cope and handle even the most difficult situations.
Saved my life! He is straight to the point, gives honest feedback, tells you exactly what you need to do, gives you good options, provides sound advice. Staff lady is also very nice.
Keva will file your insurance for you so you only have to pay your co-pay or deductible!
You can also email Keva at JBoland789@att.net
Please contact us with questions.
Dr. Joseph Boland & Associates 1024 Wildewood Centre Drive, Suite A Columbia, SC 29229 US
Mon-Fri: 9:00 am - 5:00 pm
Sat: 9:00 am - 2:00 pm
DR. JOSEPH P. BOLAND & ASSOCIATES
1024 WILDEWOOD CENTRE DRIVE, SUITE A COLUMBIA, SC 29229
PHONE: (803) 781-4265, FAX: (803) 781-7300
“Welcome to our practice. We are pleased to have the opportunity to serve you and hope that this service agreement will provide information in making an informed decision concerning our services. Please ask any time if you have questions.”
Dr. Joseph Boland is a clinical psychologist. He has been licensed by the South Carolina Board of Examiners in Psychology since 1988. He has training for children, adolescents and adults. He has extensive training in providing structured Cognitive Behavioral Therapy and Behavioral Family Therapy. If his work with you leads to problems beyond his expertise, he will help you to obtain the necessary services from an appropriate specialist. His vitae is available for review, please feel free to ask.
Dr. Doris Páez is a licensed psychologist and a nationally certified school psychologist. She has been licensed by the South Carolina Board of Examiners in psychology since 2000. She has over 30 years of experience with psychological and psychoeducational services for children, adolescents, young adults, adults and families. She is fluent in Spanish and holds unique credentials as a trained bilingual psychologist. Dr. Páez also counts with extensive work experiences in higher education, government, non-profit and healthcare systems. She is the author of over 200 publications and has presented at over 800 local, state and national events including conference keynote and commencement addresses. If her work with you leads to problems beyond her expertise, she will help you obtain the necessary services from appropriate an appropriate specialist. Her vitae is available for review, please feel free to ask.
Psychological services are by appointment only. The length of the appointment time varies based on services provided. Individual or Family Psychotherapy is may be scheduled for 38 or 53 minute sessions. Appointments are scheduled during the usual office hours: 8:00 a.m. to 7:30 p.m., Monday through Friday.
Because the appointment is reserved only for you, failure to provide adequate notice of cancellation/rescheduling (4-7 business days) generally means that another person is not able to use that appointment time. Therefore, a charge of $100 will be made for broken appointments without at least 48 hour’s notice (two full business days) prior to your scheduled appointment time.
For Monday appointments, please call before the same time on the Thursday to cancel (e.g. to cancel a 2PM appointment on Monday, please call before 2PM on Thursday. Saturday and Sunday are not days that our office conducts business. If you call to try to cancel an appointment on a Saturday for Monday
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or vice versa you will still be charged the cancellation fee). Worker’s comp patients are held responsible for missed or short notice cancellation fees. Worker’s comp will not pay for these fees so be careful about canceling appointments. If you are sick or have an emergency and have not missed or short notice cancelled any previous appointments, your psychologist may sometimes reduce the charge to $50 for short notice cancellation if he/she agrees that it was an emergency. Only Dr. Boland can waive or reduce this fee.
Problems with your car or transportation, traffic jams, inability to get off work, delays getting back from vacation, difficulty remembering the appointment time, etc. are all example on non-emergency situations that would result in a $100 charge. If an emergency arises, please call us immediately if possible to let us know you will not be able to make you appointment. If you do not show up for two consecutive appointments and do not respond to our phone inquiries, any future appointments already scheduled may be cancelled unless you call to confirm that you plan to keep them.
Dr. Boland & Associates have a confidential 24-hour answering machine to assist in rescheduling appointments. When calling after hours, please leave a detailed message including your name, the name of your psychologist, and appointment date that you need to reschedule.
Returned Check Fee Policy:
I understand that I will be charged a service charge of 30.00 (in accordance with state regulations) for all returned checks written for payment on my account. I further understand I will be required to replace the bad check, pay the service charge and all fees accrued by Dr. Boland in cash or money order within 10 days after notification.
Medical Records Fee Policy:
I understand that there will be an administration charge of $15.00 plus $0.65 per page for the first 30 pages and $0.50 per page charge for each additional page to photocopy my records.
_________ ____________ Initials Date
Contacting Us and Messages
As we work together, you will notice that we do not accept phone calls while with clients. During those times and at other times during the day or evening, our calls are answered either by the office manager or electronically. The office manager and psychologists check messages frequently during the day and we are able to return 95 percent of our calls that same day.
The office manager generally handles phone calls for scheduling and billing questions. Please call her at 803 781-4265. However, please feel free to discuss any questions or concerns about these issues directly with your psychologist during your session if you desire. If you need to speak to us during business hours (Mon.- Fri., 8a.m.-5p.m.), your psychologist will usually available five (5) minutes before each hour. After 4 PM, both Drs. Boland, Phillips and Páez stop having breaks between patients and thus are typically not be available for phone calls after 4 PM. The fee for calls or e-mails requiring your psychologist for psychotherapy issues are billed at a rate of $4.00 per minute. There will be no charge for telephone calls involving only issues like scheduling or billing questions. The office manager typically leaves around 4PM so calls after this time may go straight to voice mail so you may not be able to reach your psychologist if you are running late for your appointment after 4 PM.
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If an emergency arises after hours, you may call your psychologist directly (Dr. Boland at 348-5090 and Dr. Paez at 336-971-7685). You will be charged the fee for these phone calls is $4.00 per minute so do not call your psychologist for non-emergency issues that can wait for your next appointment. If you just need to cancel, leave a message on the regular office phone answering machine 803 781-4265. You will need to pay the charge for calls directly to your psychologist at your next session or when you receive a bill in the mail. Telephone consultation is not a covered service by insurance companies therefore you will be responsible for the cost of these services. If we anticipate that greater availability is necessary, we can discuss this and make special arrangements. In case of a life-threatening emergency, please go immediately to the nearest hospital/emergency room if you cannot reach us by phone. Again, please do not call your psychologist’s cell phone for non-emergency questions like when is my appointment.
Use of Email and Social Media
Be aware that we maintain a practice website at www.drjosephboland.com to give general information to the public. The website has an email and you may use the office manager’s email firstname.lastname@example.org to communicate with our office manager to arrange or modify appointments. Please do not email us content related to your therapy sessions as email is not completely secure or confidential. If you choose to communicate with us by email, be aware that all emails are retained in the logs of yours and our Internet service providers. While it is unlikely someone will be looking at these logs, they are, in theory, available to be read by the system administrators of the Internet service provider. You should also know that any emails we receive from you and any responses we sent to you can become part of a legal or medical record (should you find yourself in a legal situation). If you do send clinical information about yourself, the office manager will print off a copy and put it in your file to be read by your psychologist at your next session. If you want your psychologist to read the email before your session, please make a note to her to have your psychologist read the email immediately. Since insurance will not pay for this service, please add in your note that you agree to pay our $4.00 per minute fee for the time it takes your psychologist to read and respond to your note. If you do not include this agreement to pay the fee, the note will just be put in your file to be read at your next session.
Please do not use SMS (mobile phone text messaging) or messaging on Social Networking sites such as Twitter, Facebook, or LinkedIn to contact us. Do not Friend/Follow/Fan us. These sites are not secure and we may not read these messages in a timely fashion. Do not use Wall postings, @replies, or other means of engaging with us in public online if we have an already established client/therapist relationship. Engaging with us this way could compromise your confidentiality. It may also create the possibility that these exchanges become a part of a legal medical record and will need to be documented and archived in your chart.
If you need to contact us between sessions, the best way to do so is by phone. Direct email at email@example.com is second best for quick, administrative issues such as changing appointment times. See the email section above for more information regarding email interactions. Also, we do not use search engines to glean information about you.
If you should find this practice on business review site such as Yelp, Healthgrades, Yahoo Local, Bing, or others, please be aware that if you are using these sites to communicate indirectly with us about your feelings with our work, there is a good possibility that we may never see it. Please bring all concerns directly to us so that we may address these in person or by phone. Confidentiality means that we cannot tell people that you are the client and we cannot approach you in public. But you are more than welcome to approach us in public or tell anyone you wish that you are in therapy here or how you feel about the treatment provided to you, in any forum of your choosing. If you do choose to write something on a business review site, we hope you will keep in
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mind that you may be sharing personally revealing information in a public forum. We urge you to create a pseudonym that is not linked to your regular email address or friend networks for your own privacy and protection.
If you used location-based services (GPS) on your mobile phone, you may wish to know that we do not place the practice as a check-in location on such sites. However, if you have GPS tracking enabled on your device, it is possible that others may surmise that you are a therapy client due to regular check-ins at our office. Please be aware of this risk if you are intentionally “checking in,” from my office or if you have a passive LBS app enabled on your phone.
Initial Diagnostic Interview
Our initial appointment is often called a “diagnostic interview”. This appointment is scheduled for you to discuss your concerns and problems from your point of view. In addition, we will attempt to obtain relevant historical and other background data or this information may be gathered at subsequent sessions. In times of crisis, the usual format of a “diagnostic interview” may not be followed in the hope that the time might be used to resolve or relieve the immediate crisis.
The regular fee for the initial diagnostic interview is $250.00 per session up to forty-five minutes. Normally only a standard appointment time is scheduled. If scheduling permits, the time may be extended. The fee for extended time is $4.00 per each additional minute. The additional fee for the extended sessions is typically not covered by insurance and thus your responsibility at the end of the session unless prior arrangements have been made.
In addition to the “diagnostic interview”, it is often beneficial to conduct a “formal” psychological testing in the early stages of therapeutic services or in consultation with others. The decision to access using psychological instruments will be discussed with you in advance and the discussion will include the nature of the tests to be utilized and the rationale for the testing. Accurate and valid results are obtained from psychological assessment and testing only when you are willing to cooperate, motivated to do “well” and naïve to the “right answers”. As such, professional ethics mandate that the psychological tests themselves are not to be distributed to you at any time. It may be necessary to schedule a three or four hour block of time in order to accomplish a single “testing” and it is important to recognize that we may spend an hour or more in test scoring, data interpretations and report writing for every hour spent in face-to-face contact with the client. If a written report is necessary, there will be an additional charge to cover the preparation time required.
The regular fee for psychological testing is a minimum of $280.00 per evaluation This charge is for the administration time for psychological testing such as the MMPI-2 and PAI, testing for ADHD and psycho- educational testing such as IQ and Academic Achievement. It also includes our professional time for test administration, scoring, interpretation, records review, and report writing. The fee for services provided is due at the end of each testing session. Please know that local school districts may be able to provide free psycho- educational evaluation services to children suspected of having learning disabilities. You may wish to contact the special services department within your local school district to learn more about psychological services available to you at no charge.
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Drs. Boland and Páez expect and encourage you to obtain knowledge of the procedures, goals and possible side- effects of psychotherapy. They expect to make their professional contact one where you receive maximum benefit and information regarding alternatives to psychotherapy. Psychotherapy may be tremendously beneficial for some individuals while, at the same time, there are some risks. The risks may include the experience of intense and unwanted feelings including: sadness, anger, fear, guilt or anxiety. It is important to remember that these feelings may be natural/normal and are an important part of the therapy process. In therapy, patients frequently learn to better understand and control undesirable emotional feelings. Other risks of therapy might include: recalling unpleasant life events, facing unpleasant thoughts and beliefs, increased awareness of feelings, values, and experiences, alteration of an individual’s ability to desire to deal effectively and harmoniously with other in relationships. Treatment typically works to help individuals control their undesirable emotional responses to negative past events. In therapy, major life decisions are sometimes made, including: decisions involving separation within families, development of other types of relationships, changing employment settings and even lifestyles. These decisions are a legitimate outcome of the therapy experience because of an individual’s calling into questions many of their beliefs and values. As your psychologist, Drs. Boland, and Páez are available to discuss any of your assumptions, problems or possible negative side effects of your work together.
Your session time start time is typically at the time your appointment is scheduled, not when you arrive. If you are running late, we still encourage you to come in for your session because insurance will not pay for the $100 “no show” or “short notice cancellation”. The typical Individual, Marital or Family session is 53 minutes for which we charge $250. Normally, your psychologist has another patient schedule after your session so extending the session time is not possible. However, if you want additional time and your psychologist’s schedule permits extending the session, the charge is $4.00 per each additional minute. The normal fee and fee for any extended services provided are at the time of each session. The additional fee for extended sessions is typically not covered by insurance and thus 100% your responsibility. You may request in advance, a brief, 38 minute Individual, Marital, or Family Psychotherapy for which the charge is $200.00. However, a brief session must be requested at the time of scheduling because otherwise, time for a 53 minutes session will be scheduled.
Other Psychological Services
While the majority of our time is spent in providing psychotherapeutic services, at times, other psychological services are provided. These include school consultations, parenting workshops and home visits. Forensic consultations and out of office services are generally considered not to be medically necessary and thus not reimbursable by insurance.
For all forensic consultations, payment is expected in advance. The in-office and out-of-office forensic consultations is $400.00 per hour. Out-of-office consultations such as court appearances are billed portal to portal. The fee for school consultations and home visits is $300 per hour.
Psychological services provided by phone are often an important ancillary service by typically are not reimbursed by insurance companies. As previously mentioned, professional telephone consultations are billed at rate of $4.00 per minute.
Infrequently, a patient’s distress remains or becomes so high that hospitalization or the use of medication must be considered. In South Carolina, psychologists are not allowed by law to prescribe medication. In cases where
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medication or hospitalization may be required, this will be discussed in advance with you and, if necessary, with other responsible individuals (e.g. parents of children). Your psychologist works with several psychiatrists and physicians in the area and he/she often collaborate on issues of medication, hospitalization and second opinion so client’s needs are better served. Generally, our clients utilize the services of a psychiatrist or physician as a medical “consultant” while continuing psychological therapy with Drs. Boland and Páez.
Termination of psychotherapy may occur at any time and may be initiated by either the client or the psychologist. If you are unhappy with any aspect of treatment, please notify your psychologist immediately so he/she can make adjustments that will better meet your needs. If, for whatever reason, you wish to terminate before reaching the treatment goals, please first discuss this issue personally with your psychologist. Typically, termination of therapy comes after the patient has reached their treatment goals and feels capable of independently handling their life situation. Usually, as the goals are being met, the sessions decrease in frequency (e.g. session every other week, every three weeks, once a month, etc.) and finally proceed to an “as needed” basis. Please feel free to let your psychologist know if you think you are ready to decrease the frequency of sessions.
At any time, our clients may have questions and/or refuse therapeutic or diagnostic procedures or methods, or gain whatever information they wish to know about the process and course of therapy. Please feel free to discuss any concerns or questions you may have about your services as we proceed. However, you should also be aware that you are entitled to specific rights under South Carolina law and may contact the South Carolina Board of Examiners in Psychology with any inquiries and/or concerns. You may write the Board of Examiners in Psychology c/o The Department of Labor, Licensing and Regulation, PO Box 11329, Columbia, SC 29211-1329.
Clients are also assured of confidentiality that is protected by both ethical practice and by South Carolina law. There are, however, important exceptions to confidentiality that are legally mandated. In general terms, these exceptions include:
Confidentiality will be respected in all cases, except as required by law. Sometimes it may be helpful to be able to discuss your evaluation and/or treatment with others. At that time, it will be necessary for you to complete a “Release of Information” form with the name and address of those individuals, e.g., family members, physicians, psychiatrists, children’s teacher, etc., that you may wish us to contact. You may also limit the time of release validity by an expiration date, or limit what we have your permission to discuss, by simply completing the expiration date and/or releasing only permission to discuss certain subjects/ topics on the release form. You also have the right to inspect our records of your treatment. If you so desire, we ask that you arrange a mutually convenient time to do so. We will be happy to answer any questions about your records, diagnoses
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and/or any other treatment plan at any time. Should you desire to have a copy of any of your records for yourself or another treatment provider, we ask that you provide to us express written authorization for releasing such. In addition, we would ask that you please allow us at least seven days’ notice to prepare such requests.
Clients Who are Dependents
If you are requesting of services as the guardian or parent of a child, or the guardian of a dependent adult, the same general practice as outlines above will apply. Both you and your child have a right to confidentiality. It is generally best for effective treatment for the psychologist to be able to discuss issues openly. Thus, we recommend discussing the issue openly and proceeding with the policy that any information told to us by your child will be relayed to you at your request unless we have agreed to a more restrictive policy that we both feel is in your child’s best interest. As your child’s psychologist, sometimes it is important to give your child confidentiality from you so that your child will be able to completely trust us and openly discuss sensitive issues. As such, sometimes parents grant their child an informal privilege by not asking us what your child says. As the parent or guardian, you would still have the right and responsibility to question and understand the nature of any activities and progress with your child. We enjoy being able to discuss your child’s progress and your participation in their treatment.
The charges for our services are based on the usual, customary and reasonable fee profiles for this area. We encourage you to discuss fees any time. Our clients are expected to pay for services when provided unless arrangements have been made in advance. A $10.00 late fee is added if you do not pay at the time of service for your co-pay, co-insurance, deductible or full fee in not covered by insurance. During the day, we typically schedule appointments on the hour, leaving a short break between appointments. Since we always have many requests for late afternoon appointments (4:00 p.m. or later), we start sessions back to back and request that your check for payment be made out in advance so that our entire time may be spent attending to your concerns. If you are concerned about not being rushed, we recommend you ask for day appointments. Payment in full is necessary prior to our beginning a written report containing assessment, testing results and/or treatment recommendations.
If you have a health insurance plan, your visits may be reimbursed by your insurance company. Since you have a contract with your health insurance carrier, it has been our experience that they are more responsive to you, the insured, than to us, the provider. If you want our office to file your insurance, we need to verify your insurance coverage prior to your visit. Since insurance companies never guarantee the quotes they provide over the phone, the information that we receive is not a guarantee of payment. Therefore, the balance of the account will always be your responsibility. If your insurance company denies your claim, we will be happy to assist you in any appeal to the insurance company, but you will be required to pay the balance first and request the insurance reimburse you for the disputed amount.
Your insurance company will require diagnostic and treatment information before issuing payment. We will release that information to them with your permission. If you wish, we will be happy to discuss with you the
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“diagnosis” that we are releasing to the insurance carrier. While a client’s diagnosis is very sensitive information and is generally treated as such by insurance carriers, we cannot guarantee how a particular insurance carrier or employer protects this information. If you prefer that we do not release information to your insurance carrier for reimbursement purposes or if your insurance carrier fails to reimburse in a manner we expected, you will remain responsible for the fee for the services.
Many individuals are members of preferred provider plans with whom we have contractual obligations. Please inform us in advance should you be eligible for these contracted services to prevent insurance billing mistakes that may jeopardize your utilization of these plans. Your insurance company will notify us on the Explanation of Benefits (EOB) if a discount applies for a service you received.
I request that payment of authorized Medicare, BCBS, Medicaid, or Private Insurance benefits be made either to me or on my behalf to this office for any services rendered by Dr. Boland. I authorize any holder of medical information about me to be released to the Health Care Financing Administration and t it agents, DS or Private Insurance carrier specified to determine payable for services rendered. I permit a copy of this authorization to be used in place of the original.
If my coverage is under a group contract held by an employer, an association, trust fund, union or similar entity, this authorization permits disclosure to them for purposes of utilization review or audit.
This authorization shall become effective immediately, upon execution and shall remain in effect for the duration of any claim or term of insurance coverage including a reasonable time thereafter, until its final consummation.
I understand that I am financially responsible for all deductible, co-pays and non-covered services at the time services are rendered. I further understand I am financially responsible for all collection fees (33% of total balance), attorney fees or legal fees required to collect any balances due to me.
________ ________ Initials Dates
Although we only accept cash or checks for payment, the billing service we use accepts credit card payments, and the merchant processes all payment with a 5% processing fee.
Missed and Cancelled Appointment Policy:
I understand that I will be charged $100.00 for all missed and cancelled psychotherapy appointments unless I provide 48 hours (two business days) notice.
For psychological testing appointments, I understand the charge will be $100.00 for each hour scheduled unless I proved at least ten business days notice (Most patients only schedule psychotherapy appointment so this would not apply to most patients).
_______ _________ Initials Date
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DO YOU WISH TO DESIGNATE A FAMILY MEMBER OR OTHER INDIVIDUAL WITH WHOM THE PROVIDER (DRS. BOLAND, PHILLIPS and/or PAEZ) MAY DISCUSS YOUR MEDICAL/PSYCHOLOGICAL CONDITION?
IF YES, WHOM?_____________________________, RELATIONSHIP TO YOU__________________ BEST METHOD FOR CONTACT: ________________________________________________________
“We again welcome you to our work together and anticipate that it will be mutually beneficial.”
I _____________________ have read the above material, consent to treatment and agree
to abide by the terms as outlined.
______________________________ _________ Signature of Client or Person Date Responsible for Payment for Services
__________________________________ _________ Joseph Boland & Associates Staff Date
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JOSEPH BOLAND & ASSOCIATES 1024 Wildewood Centre Drive, Suite A Columbia, SC 29229
Phone: 781-4265, Fax: 781-7300
Joseph P. Boland, Ph.D.
Licensed Clinical Psychologist ___________________________________________________________________________________________________
ADULT INTAKE QUESTIONAIRE
Name: ______________________________________Today’s Date:_______________ Address:_______________________________________________City_____________ Zip Code:_____________________
Telephone: (Home)_________________ (Work)______________________ (Cell)__________________________
Social Security Number: _________________________ Age:__________ Birthdate:________________________ Employer:__________________________________________________ Occupation:_________________________________________________
Marital Status:______ Single ____ Married_____ Divorce______________ Emergency Contact: ________________________ Phone: ______________________ Who Referred you to our office?____________________________________________ Reason for Service: ______________________________________________________ Signature:_____________________________________________ Email:__________________________________________________
JOSEPH BOLAND & ASSOCIATES 1024 Wildewood Centre Drive, Suite A Columbia, SC 29229
Phone: 781-4265, Fax: 781-7300
CHILD INTAKE QUESTIONAIRE
Name: ______________________________________Today’s Date: ________________
City_____________________________ Zip Code:__________
Telephone: (Home)_______________________ (Work)_______________________
Emergency Contact: ___________________ Contact Number: _____________________
Mother’s Name: ______________________________________
Date of Birth:___________________ Age: __________
Briefly describe your reason for seeking our services: _______________________________________________________________________
Who Referred you to our office?_____________________________________________ Signature:____________________________________ Email:___________________________________________________