For Appointments: (515) 294-5801

Forms and Policies

Are you a student needing your health records? If so, follow this link for more information.


COVID-19 Forms

If you are an Iowa State University Student, Faculty or Staff member, please use these forms for Contact Tracing and Campus Testing.

Self-Reporting Form for Postive COVID-19 Results (not performed at TSHC)

Pre-Testing Questionnaire

Pre-Testing Questionnaire for Department of Residence Move-In

Email Message Template for Supervisors (automatic download)


Forms

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!

Complete these for your FIRST visit:

Consent for Services and Communication (Download fillable form)

Iowa State University Notice of Privacy Practice for Patients (HIPAA Information)

Insurance Information Form

Insurance Information Form

Submit the form to Medical Records Department.

By E-MAIL:  shcreco@iastate.edu

By MAIL:
Medical Records
2647 Union Drive, Iowa State University
Ames, IA 50011-2029

By FAX: 515-294-5457

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Complete these forms as needed, based on your type of visit:

International Travel Questionnaire

Policies

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