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Birth Control Supplement Disclosure Card

A simple disclosure card for birth control and supplements: what to list, what to bring, what to ask, and what to keep out of shared notes.

Supplements can feel too small to mention.

Mention them anyway.

This card helps you list vitamins, herbs, gummies, teas, powders, and other supplements before a birth control question. It does not say a supplement works. It does not say a supplement is safe for you. It does not tell you what to take.

Wallet card

Copy this into a note or print it.

Prompt Your note My birth control method Birth control name or brand Supplement 1 Supplement 2 Supplement 3 Other medicines Main question Pharmacy or clinician to ask

Keep it short.

Bring packages or label photos if you can.

Supplement label list

Use the label words.

Supplement name Form Label amount How often used Start date Question pill / gummy / tea / powder / drop / other

Do not guess at label amount.

Write "not sure" if the label is unclear.

What to bring

Birth control package or method card. Supplement bottles or photos. Pharmacy medicine list. Clinic portal medicine list. Allergy list. Start dates, if known. Any symptom notes you want reviewed. Your main question.

This is a disclosure tool, not a care plan.

Say this at the pharmacy

Use this script.

Then show the card.

Ask the clinician

Pick what fits.

Do you want my full supplement list? Should I bring the bottles? Could any supplement matter with my birth control? Could any supplement matter with my symptoms? Should a pharmacist review this list? Which symptoms should I track? What should I not start, stop, or mix without advice? Should this go in my chart?

Ask about your case.

Do not use another person's answer.

One page visit note

Fill this in before a visit.

Summary item Your note Birth control method Main supplement question New supplement New medicine Symptom to review Pharmacist review done yes / no / not yet What I want help with What I want to keep private in app notes

Privacy light disclosure

Supplement and birth control notes can show private facts.

They may show sex health, fertility concerns, pregnancy worry, clinic names, pharmacy names, location, or health goals.

Use the least detail that still helps care.

Instead of Try Full bottle photo in a shared folder "Supplement label saved privately." Long app note with birth control and sex details "Private birth control question." Full list in a lock screen reminder "Supplement review." Clinic message copied into a calendar "Clinician reply saved privately."

HHS says HIPAA does not cover every consumer health app. FTC guidance tells health apps to limit data collection and access.

Floriva can hold short notes on your device. It does not promise privacy. It does not replace your pharmacist, clinician, package label, or patient handout.

For the full list, use the birth control medicine interaction checklist. For app note cleanup, use the birth control data privacy checklist and period tracker data minimization guide.