Many of our most highly used forms are available for you to complete before your appointment. It is not mandatory that these forms are completed in advance. It is simply a way to speed up your visit, as we know students are busy!

Authorization for Release of Healthcare Information (Medical Records Request)

Consent for Services and Communication Form

Iowa State University Notice of Privacy Practice for Patients Form

Insurance Information Form

Sliding Fee Discount Program Application

Gynecological History Form

Traveler History Form

Consent for Verbal Communication

Revocation of Authorization of Release of Healthcare Information or Consent for Verbal Communication

Submit forms to the Medical Records Department at, by fax at 515-292-9135, or by mail by addressing the from to Medical Records, 2647 Union Drive, Iowa State University, Ames, IA 50011-2029.

Click here for more information on requesting your medical records.


Iowa State University Thielen Student Health Center is governed by the policies of Iowa State University. Although there are numerous policies that apply to the health center, there are a few that are often referenced and therefore called out below.

Patient Rights

Each patient has the right to:

  • Ask questions about my treatment.
  • Choose among Thielen's healthcare providers and change providers, if available.
  • Be informed about my diagnosis, evaluation, treatment options and prognosis; participate in healthcare decisions except when the participation is contraindicated for medical reasons.
  • Continuity of healthcare between Thielen, hometown, and consulting healthcare provider.
  • Request a second opinion from a healthcare provider or mental health professional.
  • Appropriate privacy and, if requested, a chaperone.
  • Information about services provided, my eligibility for those services and fees and payment options.
  • Information about how to seek care after hours and in emergencies.
  • Private, confidential, and secure medical records.
  • Information about the credentials of Thielen healthcare providers and consultants.
  • Submit grievances regarding treatment or care that is, or fails to be, furnished.
  • Treatment with respect, consideration, dignity, and without discrimination or bias based on the basis of protected class status.
  • Terminate treatment at any time.
  • Right to receive a cost estimate
  • Protection from surprise medical bills


All memberships and locker services are non-refundable except under the following circumstances:

  • Member has a documented medical or health condition that will not allow them to use the facility
  • Member will be on military deployment
  • Member is faculty/staff who is no longer employed by the university
  • Member is faculty/staff with a change in employment status (i.e. shift change or newly assigned remote work)


Not all memberships are eligible for cancellation. Only members on an annual month-to-month membership are eligible to cancel the unused portion of their membership if the following criteria are met:

  • Annual month-to-month membership: After Cancellation/Refund Request Form is received and approved, membership will be cancelled at the end of the same month the request is received. Example: cancellation request received April 10th; membership ends on April 30th


  • Cancellation/Refund Request Form must be completed and any request. Any applicable documentation must be provided to request a cancellation or refund
  • Upon approval, a refund will be processed within 7-10 business days
  • Approved refunds will be processed on a prorated basis and refunded back via the original method of payment


All Recreation Services patrons are expected to be responsible, courteous, and safety conscious at all times. Disorderly conduct, abuse or misuse of the facility or its equipment, or disregard for policies will not be tolerated.  Usage privileges may be revoked or suspended for policy violation at any time.

Policies are posted on site and are located at specific areas throughout the recreation facilities.  All Recreation Services policies can be located on our website. All policies outlined in the Student Disciplinary Regulations (Code of Conduct) will be enforced. The Student Disciplinary Regulations (Code of Conduct) can be found on the ISU Website under the Policy Library.

Violators will be required to leave the facility and may be subject to disciplinary action. Violators of Recreation Services policies may also be suspended from using the facilities and programs. Users who are suspended will not have any portion of their fees refunded.


  • All users must present a valid ISUCard upon entry or be sponsored by a member and purchase a daily guest pass
  • Recreation Services reserves the right to refuse admittance. Upon request an ISU ID or pass must be shown to staff.
  • Entry to and exit from the facility must be through controlled access points only. Other exits should be used for emergencies only.
  • The Recreation Services app may be used in place of an ISUCard.

Dress Code

Rec Services strives to maintain a clean, safe, and inclusive environment while honoring personal workout clothing preferences.

  • Shirts/tops, shorts/pants, and closed-toes shoes must be worn at all times other than in the pool and locker rooms.
  • Clothing cannot display offensive language.
  • Appropriate, clean, closed-toe, non-marking, athletic shoes are required in all activity areas.  Street shoes or shoes that mark the floors are prohibited.
  • Clean attire that is intended for swimming must be worn in the pool and hot tub (no workout clothes).
  • Gender specific attire is not required within any of our recreation facilities. Participants are encouraged to wear attire that honors their workout experience most.

General Policies

  • Intramurals, Sport Clubs, Campus Organizations, University Affiliations and groups with advanced reservations approved through the Recreation Services scheduling office have priority over all other groups.
  • Racquetball and squash court participants are given priority over other activities in those designated courts.
  • Non-university groups conducting organized practices may ONLY use the courts on a space-available, hourly rental basis. Details available at Recreation Services central administrative offices.
  • No type of sports activities are allowed in hallways.
  • Hanging from rims or nets is prohibited.
  • Bicycles, scooters, in-line skates and skateboards of any style, are prohibited from being used inside Recreation Services facilities.
  • The use of audio devices is restricted to Recreation Services staff.  Please use headphones/earbuds to listen to your audio content.
  • Animals are not permitted in facilities except trained service animals. Companion animals are not allowed.
  • Only non-alcoholic beverages in closed, re-sealable plastic containers are allowed in activity areas. Gum, tobacco and alcoholic beverages are not allowed. Food is not allowed unless permitted otherwise.
  • Solicitation, private classes, personal training, or any other activity associated with personal gain is not permitted.

Fitness Area Policies

  • Tops, bottoms, and closed-toed athletic shoes must be worn at all times
  • Users are required to re-rack weight plates and dumbbells when finished
  • Equipment may not be removed from Fitness Area
  • Wipe down equipment after use
  • Users are to abide by all staff requests
  • Collars must be used on all barbell lifts
  • Personal Training or private instruction is restricted to Recreation Service employees
  • Cubbies are for storage only. Do not set weights on cubbies or use them for exercise
  • Equipment may not be altered or used for anything other than the designed function
  • Food, tobacco/vaping products, open beverage containers, or mixing supplements is prohibited in the Fitness Area
  • Dropping of weights or cable stack is prohibited. Weights must be controlled throughout the entire movement
  • Gym Chalk is prohibited
  • Do not place weights on benches. Do not stand or step on benches.

Lied Athletic Recreation Center

  • The Athletic Department has priority over the main floor area in the Lied Recreation Athletic Center Monday – Friday from 2 PM – 6 PM and Saturday from 8 AM- Noon during the fall and spring semesters.
  • In the Lied Recreation Athletic Center, footballs are permitted on the turf, but cannot be kicked or punted.
  • In the Lied Recreation Athletic Center, pass holders with young children may walk their child in a stroller, on the lower track, between 8 AM and Noon, Monday through Friday. Children must remain in the stroller times.
  • Sports such as but not limited to: baseball, softball, cricket, golf, lacrosse and soccer are limited to only the Lied Recreation Athletic Center during scheduled reserved club times or during morning hours when other patron’s safety is not at risk from the activity.  Facility Supervisors will make this determination and at any time may end the activity.
  • Sport Clubs may practice during scheduled times with limits to control play in a safe manner.

Non-Discrimination Policy

  • Iowa State University and the Department of Recreation Services does not discriminate on the basis of race, color, age, ethnicity, religion, national origin, pregnancy, sexual orientation, gender identity, genetic information, sex, marital status, disability, or status as a U.S. Veteran. Inquiries can be directed to the Office of Equal Opportunity and Compliance, 3350 Beardshear Hall, (515) 294-7612.
  • Recreation Services is committed to assuring that its facilities, programs, or services are free from discriminatory, inappropriate, and disrespectful conduct or communication.
  • Verbal or written abuse, threats, intimidation, violence, or other forms of harassment towards participants or staff will not be tolerated.
  • All participants and staff are expected to respect the rights of others and to be civil, effective citizens of the ISU community.
  • Information regarding policies on transgender participation may be found on our Inclusive Rec page.

Social Media/Photography/Video

  • The Recreation Services Department normally takes photographs, video, and/or tape recordings of our various programs, activities, or special events. During these various programs, a photograph or video/audio recording may be taken of you. Unless you request otherwise, your participation will be considered permission for Iowa State University and the Department of Recreation Services to photograph, film, audio/video tape, record and/or televise your image and/or voice use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions. If you object to Recreation Services using your image or voice in this manner, please notify the Department of Recreation Services.
  • Any individual(s) who seeks to film (photograph/video), interview, or conduct class projects in any Recreation Services facility must first receive permission from the Recreation Services Marketing team. Taking pictures or selfies via cameras, video cameras, and video-ready cell phones is strictly prohibited in the men’s and women’s locker rooms, restrooms, and the pool (excluding Recreation Services programming). Photography and video of one member by another requires their consent. Photos and video in the locker rooms or restrooms compromise the privacy of Recreation Services members and will not be tolerated. Members are encouraged to report all violations of this policy to our front desk staff.
  • Apply for Media Pass


By participating in activities or using equipment and facilities offered by ISU Recreation Services, patrons knowingly and voluntarily ASSUME ANY AND ALL RISK of injuries, regardless of severity, which may occur as a result of participation in aquatics, sport clubs, fitness classes, intramural sports, outdoor recreation (climbing or bouldering wall), self-directed exercise and/or other activities provided by Recreation Services. Recreation Services is not responsible for lost or stolen items.



  • ISU Student Athletes must show a valid ISUCard and swipe into the facility.
  • Spectators associated with ISU Athletic Events will be allowed access through the main southwest entrance. Facility access is limited to the event venue and restrooms only.
  • University employees conducting business will be granted access.
  • Visitors need to enter through the main southwest entrance and state their business.

Camps / Clinics

  • Participants and coaches access will be through the main southwest entrance. Camp/Clinic participants must be under the supervision of the Team Camp staff and are allowed in only areas that are reserved for the event.


Multipurpose Room 3430

This space is used on a reservation only system.  This area is locked and secured unless a group has it reserved.  Groups need to follow this procedure to access this area:

  • During scheduled club practices or group reservation you need to go to the Beyer Hall Service Center Desk at the main entrance
  • Inform the Beyer Attendants which club/group they represent and the area they need to access.
  • A Beyer Attendant will accompany the club/group to the area and allow them entrance into the space.
  • Once the scheduled time is completed the club/group needs to vacate the space.


Club Storage Cages Room 1500

Clubs that have storage cages/cabinets in Beyer Hall Room 1500 need to follow this procedure to access those areas:

  • Go to the Beyer Hall Front Desk at the main entrance.
  • Inform the Beyer Attendant which club they represent and the area needed to access.
  • A Beyer Attendant will accompany the club to the area and allow the club entrance into the space. Each club will have a key checked out to them to access their club cage/cabinet.
  • Once the club leaves this area they need to ensure the door is locked behind them.
  • The club should notify the Beyer Attendant at the Front Desk that they are done accessing that area.


Bicycles, scooters, in-line skates and skateboards of any style, are prohibited from being used inside Recreation Services facilities.


  • There are no public bulletin boards located in Recreation Services facilities.
  • Postings may not be affixed to walls, windows, doors, or other surfaces unless approved by Recreation Services.
  • All tabling, banners, flyers, or other signage must be pre-approved by Recreation Services.
  • All material must be related to the Student Health and Wellness Unit.
  • Recreation Services reserves the right to remove any material at any time.


  • All tabling must be pre-approved by Recreation Services
  • Activity being promoted must be related to ISU sponsored/endorsed activities; i.e. Student organizations, academic units, etc.
  • Material must not be offensive and appropriate for public viewing.
  • Recreation Services reserves the right to cancel tabling arrangements or ask tabling organization to leave at any time


All Recreation Services users are expected to be responsible, courteous, and safety conscious at all times.  Disorderly conduct, abuse or misuse of the facility or its equipment, or disregard for policies will not be tolerated.  Violators will be required to leave the facility and may be subject to disciplinary action.  Violators of Recreation Services policies may also be suspended from using the facilities and programs.  Users who are suspended will not have any portion of their fees refunded.

The Student Code of Conduct will be the basis for how individuals should conduct themselves within our facilities and programs.  Conduct issues will be reviewed on a case by case basis by Recreation Services with appropriate disciplinary actions handed out.  Additional disciplinary actions may be given by the Office of Dean of Students Judicial Affairs.

Service Animal Policy

Recreation Services and Student Health and Wellness practice the official policy for Animals on Campus outlined in the Iowa State University Policy Library.

Client Forms

Release of Information (Sign electronically)

Release of Information (Print and Sign)

Parental Consent for Treatment of a Minor (Sign electronically)

Fee Appeals Form (Sign electronically)

Policy Documents

Notice of Privacy Practices

Privacy Practices

Iowa State University Student Counseling Services (SCS) is a component of the Iowa State University Health Care Providers. As a Iowa State University Health Care Provider, we abide by the Privacy Practices outlined in the Notice of Privacy Practices for Iowa State University Health Care Providers. When you come for you initial appointment, you will be asked to acknowledge in writing that you have seen this notice. We recommend you review it carefully as it describes how medical information about you may be used and disclosed as well as how to access this information, In addition to the pdf version available on this page, we also maintain copies in our waiting and at the front desk.

Confidentiality Policy

As spelled out in our Privacy Practices, we adhere to the Health Insurance Portability and Accountability Act (HIPAA) to guard your protected health information. Further, we are also guided by our professional code of ethics, which state that all services of the Student Counseling Service are strictly confidential. Staff typically cannot release any information regarding clients, or the services they receive, to anyone outside of the Student Counseling Service without the written permission of the client. In those rare situations in which students indicate a high likelihood of harming themselves or others, staff may be legally required to release client information (with or without written consent) to protect the safety and will-being of the person(s) involved. Further, all counseling staff are considered “mandatory reporters” under Iowa law, meaning that in certain situations we are compelled to report suspected cases of child abuse, elder abuse, or dependant adult abuse to the proper authorities.