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Practice Name

Chiropractic and Acupuncture

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Primary Location
Serving
Tampa, St Pete, Clearwater, Brandon, Orlando, Pinellas Park, FL 33614
Phone: 813-835-4488
Fax: 800-518-9398

Office Hours

DayOpenClose
Monday8:00 am7:00 pm
Tuesday8:00 am7:00 pm
Wednesday8:00 am7:00 pm
Thursday8:00 am7:00 pm
Friday8:00 am7:00 pm
SaturdayBy Appt.By Appt.
Sunday8:00am12:00pm
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Assignment and Release

Name of the Insured _____________________________________________

I certify that I, and/or my dependents(s) have insurance coverage with ______________________ (Name of Insurance Co.) and assign directly to Dr. Thomas T. Mang all insurance benefits. If any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I authorize the use of my signature on all insurance submissions. The above-named doctor may use my health car information and my disclose such information to the above-name insurance co. and their agents for the purpose of obtaining payment for services and determining insurance benefits or the benefits payable for related services. This consent will end when my current treatment plan is completed or one year from the date signed below.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

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Services We strive to provide complete care for our patients. Learn more about all the services we provide. Make An Appointment We will do our best to accommodate your busy schedule. Schedule an appointment today! Acupuncture Acupuncture is a complete medical system originated from China more than 3000 years ago.

Office Hours

DayOpenClose
Monday8:00 am7:00 pm
Tuesday8:00 am7:00 pm
Wednesday8:00 am7:00 pm
Thursday8:00 am7:00 pm
Friday8:00 am7:00 pm
SaturdayBy Appt.By Appt.
Sunday8:00am12:00pm
Day Open Close
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00 am 8:00 am 8:00 am 8:00 am 8:00 am By Appt. 8:00am
7:00 pm 7:00 pm 7:00 pm 7:00 pm 7:00 pm By Appt. 12:00pm

Contact

  • Serving Tampa, St Pete, Clearwater, Brandon, Orlando, Pinellas Park, FL 33614
  • 813-835-4488
  • Get Directions
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