FAQ

SCHEDULING

Q: How Do I schedule an initial visit or future office appointments

A: Please submit an application to become a patient here. Our office will give you a call within 5 business days to let you know if you've been accepted to the practice.

Initial visits and follow up visits can be scheduled via phone or email.

We recommend scheduling your follow up visits immediately following your appointment with your provider to ensure you are seen in a timely manner. Because our practitioners are scheduling follow up visits 6-12 weeks in advance, it is not possible to guarantee availability should you delay scheduling.

Scheduling within 24 hours of your visit is advised to ensure there is no delay in your treatment.

To learn about the case review and how to establish care, read more here.

Q: What is it like to work with Dr. Jolene Brighten and her team?

Check out in depth info here: https://drbrighten.com/work-with-me/

Q:How is Dr. Brighten different from other NDs or Functional Medicine doctors?

Dr. Brighten take a team approach to care, which you can read about here.

She also has a very unique approach to patient care and how she approaches autoimmune and hormonal disorders. You can read this story about one of Dr. Brighten's Hashimoto's patients that she helped heal in Portland.

SUPPLEMENTS

Q: How do I order recommended supplements?

For patients, supplement orders can be placed through our online store.

 

Q: Can I Buy Supplements on Amazon?

I can’t recommend any brands that I have not researched for quality or third party testing. I only recommend brands which I have researched and trust, which includes having spoken to the company directly myself. I therefore, can not recommend taking supplements ordered on Amazon or other online sources.

Because many doctor-grade brands do not sell directly to the consumer, I do advise caution when purchasing supplements on websites such as Amazon.

 Prescriptions:

Q: I am almost out of my medication, how can I order a refill?

A: Contact Your Pharmacy for a Refill Request

If you are running low on your prescription, please ask your pharmacy for a refill request. Your pharmacy will fax us the request (510) 255 6078.

Please give ample time (1-2 weeks) before running out of your medication. Please know any adjustments to the dosage will require a visit and will be called in as a new prescription.

Prescriptions for Hormone Replacement Therapy (HRT)

Q: How often do I need refills for my medication?

A: Generally every 30-90 days

You will need to call your pharmacy to refill your prescriptions and ensure you don’t run out of your hormones.

After three months, there will need to be a follow up with Dr. Brighten before the next hormone prescription is released from the pharmacy. Please contact our office to schedule an appointment to ensure you do not lapse on your prescription. We advise scheduling immediately after your visit for this reason.

There may be lab work required before a refill request can be granted. Please allow adequate turn around time (generally 1-2 weeks) for lab results when considering your refill request.

Q: How do I make sure I don't run out of my prescription?

A: Schedule your follow up visits in a timely manner.

To prevent running out of hormones: Please allow two weeks from the time you get your recommend lab testing done for the office to receive your results. We advise contacting the office in advance to schedule your follow up with Dr. Brighten, and have your prescription sent to you on time.

It is your responsibility to ensure you have enough prescription left before your next appointment.

Q: What side effects should I contact the office about when on HRT?

Please let us know immediately if:

  • You have a period for the first time, after having stopped menstruating for a year or more

  • There is spotting in-between periods.

  • There are severe side effects that are hindering your quality of life.

  • You miss a period.

  • You become pregnant.
  • You experience severely heavy bleeding.

  • There are any changes in medications or your health condition

Contact Emergency Medical Services or Call 911 if you experience the following:

  • Shortness of breath
  • New onset of a severe headache
  • Swelling in your limbs
  • Chest, abdominal, limb pain
  • Eye pain, vision loss
  • Any symptom you perceive as life threatening

Labs

Q: Where do I get my blood work done?

A: Labcorp, Quest, Theranos or any lab your insurance provider covers

Labcorp is integrated with our patient portal, which makes for a faster turn around time on labs.

Print your lab order provided to you on the patient portal and take to the Labcorp nearest you. You can find the location nearest you :  https://www.labcorp.com/wps/portal/findalab

Theranos has limited locations, but is an affordable alternative for patients with no lab insurance coverage or high deductibles.

 

Q: Which Blood Testing require fasting? 

A: Labs that always require fasting for 12 hours before the blood draw. (For example if you are schedule for a 9am draw, do not eat after 9pm the night before.) These labs require fasting:
  • Insulin
  • Cholesterol
  • Homocysteine
  • Glucose

Q: What labs will my insurance cover?

A: We recommend contacting your insurance company directly.

Because plans vary so widely, we recommend verifying coverage with your insurance provider before getting labs done. Some insurance companies will only cover labs ordered through your primary care provider, as is the case with HMO plans.

Please communicate your individual needs with our office. Depending on which labs you need, low cost labs may be available if you are unable to use your insurance.

Q: Why do I need a full thyroid panel, and not just TSH?

A: TSH is a pituitary measurement alone and does not indicate the response of the thyroid or the ability to convert to T3. Autoimmune thyroiditis is found in about 90% of hypothyroid patients. It is an autoimmune disease, which is treated differently than hypothyroidism alone. Antibodies are predictive of the disease, meaning that they can show up years before enough thyroid tissue has been destroyed to render you hypothyroid. Furthermore, Hashimoto's (Autoimmune hypothyroid) is associate with upwards of a 14% increased risk of developing other autoimmune conditions.

Testing a full thyroid panel ensures that we do not miss a disease in its early stages. Your chief complaint for seeing me is fatigue, depression and anxiety, which all warrant examination of the thyroid. It is well established that these symptoms can be a manifestation of thyroid disease.
Q: What is Ferritin, and why do we test it? 
A: Ferritin is the storage form of iron. If iron stores are getting low then we know that you may develop anemia and are having an iron absorption issue. I'd rather know if your iron stores are low then wait until you have anemia because it is far better to prevent a condition than to treat it.

SPECIALTY LABS

Q: What specialty labs might Dr. Brighten recommend?

A: Stool Culture, Salivary Cortisol Panel, Advanced Cardiac Screening Panel, Lactulose Breath Test (SIBO Test) are some of the common labs ordered in our office. However, recommendations are individualized. Dr. Brighten only orders labs that she determines to be medically necessary.

These kits will be either given in office, or mailed directly to you. We highly recommend that you complete all labs sent to your home or requested by Dr. Brighten as soon as possible. Many lab tests take 2-4 weeks to complete, so it’s important that you do your part to make sure these test results are in before your follow-up appointment.

Many specialty lab prices have already been negotiated for direct pay to reduce the patient's cost. As such, payment for lab kits is due at the time of ordering/ dispensing of kit.

Q: Should I do my labs if I have been sick or on Antibiotics? 

It is generally good to wait about a week after having been ill to do the ASI testing because an illness will effect cortisol secretion. The antibiotics do not impact ASI, but will affect SIBO or stool cultures.

Q: What is a SIBO Kit (Lactulose Breath Test)?

A: Small Intestinal Bacterial Overgrowth

Your SIBO test will be ordered by our office. We will then send you a link to complete the payment to the lab company. You will have an opportunity to submit your insurance information for reimbursement directly with the lab. Once your payment has been received the SIBO Lab will ship out the kit!

Please read instructions thoroughly before beginning collection.

For more information on the SIBO kit: http://sibocenter.com/category/faqs/

SIBO Brochure: http://sibocenter.com/files/2014/03/SIBO_Brochure_12_30_14.pdf

Prep Guidelines: http://sibocenter.com/files/2014/03/SIBO-Prep-Guidelines.pdf

Q: What's the difference between a stool culture (CSA) and SIBO test? 
A: The stool culture only evaluates your large intestine. The lactulose breath test evaluates your small intestine for a condition called SIBO. https://drbrighten.com/sibo-symptoms-what-is-it-how-do-i-know-if-i-have-it/

Q: Can I take antimicrobials during the SIBO Prep diet?

A: Do NOT take the SIBO test until you've been off of herbal antimicrobials for 2 weeks.

Q: Will my thyroid medication interact with the SIBO kit?

A: No, take hormone medication and then drink the solution 30 minutes later

Q: What is an ASI kit?

A: The Adrenal Stress Index (ASI) is used to evaluate adrenal function. In addition, the test will evaluate glycemic control using multiple salivary insulin measurements, gluten sensitivity and additional hormones pertinent to adrenal health.

The ASI kit is a saliva test sent directly to your house. Your account will be charged using the card you have on file at the time the kit is ordered.

The kit comes with detailed instructions. Please read thoroughly before beginning the test.

ASI overview: http://www.diagnostechs.com/Pages/ASIPatientOverview.aspx

FAQ's: http://www.diagnostechs.com/Pages/PatientFAQ.aspx

Lab Kit Instructions: http://www.diagnostechs.com/Literature/AASI%20Kit%20Instructions.pdf

Q: WHEN PREPPING FOR THE ASI DIET / CAN I HAVE COFFEE OR FOOD?

Don't eat after dinner. Collect saliva upon waking.

If you drink coffee or tea, wait until after the first vial collection.

Eat 75 grams of carbs at 11 am and collect at 12 pm. There are examples of carbohydrate servings in the instructions provided.

 

Q: WHEN PREPPING FOR THE ASI DIET / CAN I TAKE MEDICATION OR WEAR LOTIONS?

No medications the day of collection, or topical products for 24 hrs prior unless medically necessary, as they may interfere with results. Lotions, deodorants, and any products on your skin can be absorbed and may interfere with results.

Q: What is a CSA kit?

A: Comprehensive Stool Analysis (with or without parasitology)  This test is useful for: Gastrointestinal Symptoms, Autoimmune Disease, IBD/IBS, Inflammation, Food Sensitivities, Nutritional Deficiencies, Joint Pain

You will be receiving a kit in the mail to complete the test, please follow the included instructions, and prep diet.

Kit Instructions: https://www.doctorsdata.com/resources/uploads/collection_instructions/CSAP3%20INS%20US%20FEDEX.pdf

 

Q: WHEN PREPPING FOR THE CSA KIT: Can I take Probiotics?

No. Refrain from taking probiotics for 2 weeks prior to specimen collection. Store bought yogurt is likely okay unless organism count is in the billions, but please note this could impact test results.

 

Q: WHEN PREPPING FOR THE CSA KIT: Can I take Anti-fungal or Antibiotic Medications?

No. Refrain from taking probiotics for 3 days prior to specimen collection. NEVER DISCONTINUE PRESCRIPTION MEDICATIONS WITHOUT FIRST CONSULTING YOUR DOCTOR

 

Q: WHEN PREPPING FOR THE CSA KIT: What else should I avoid?

For 2 days leading up to collection, and on collection day, avoid digestive enzymes, laxatives, mineral oil/castor oil, antacids, aspirin, and substances containing barium and/or bismuth.

 

Q: WHEN PREPPING FOR THE CSA KIT: What else should I know for the prep diet?

For 3 days leading up to collection, you should consume 60-100 g/day of dietary fat to properly assess fat absorption.

BILLING

Q: When will I be charged for the visit?

Payment for all services and dispensary items is due the day of your visit. We do require a credit card be kept on file for all patients. The card on file will be used for billing, labs, no-show, and late cancellation fees unless another form of payment is arranged 24 hours in advance.

In the event that you do not have a valid card on file, you will be contacted prior to your visit to update your information.

Q: What is the Cancellation Policy?

We require a minimum of 2 business days (excluding Saturdays and Sundays) notice for return patients and 5 business days notice for new patients when canceling or rescheduling appointments. If we do not receive a minimum of 2/5 business days notice, you will incur a credit card charge of 100% of the scheduled office visit cost by 5pm on that business day.

Q: What other services incur fees?

Telephone calls greater than 5 minutes and requiring medical prescriptions, medical decision making or medical record keeping will incur charges. Telephone calls about new conditions or questions regarding health concerns that were not discussed at the previous visit will require an in office appointment. Additional fees may apply depending on services rendered, supplements, labs or other items. Patient Records Copying fees vary depending on length and type of records needed. Fees are subject to change.

Q: Why don't you take insurance?

Dr. Jolene Brighten and other California Naturopathic Medical Doctors are not recognized providers for any insurance companies nor does Dr. Jolene Brighten, ND submit claims to insurance companies on your behalf. We will however, provide you with the information necessary for you to submit your claim to your insurance company. This does not guarantee any coverage from your insurance company.

Q: How can I get Invoices and Superbills to submit to insurance companies?

Check the “BILLING” Section in the patient portal, if you are missing an invoice please submit a request to the Office Manager through the patient portal. Please allow up to 1 business week to fulfill all billing requests.