Patient Intake Form

  • I, being of legal age (18 or older), understand that I am responsible for all accounts with All American Orthopedic including any rendering Physician that may provide services during my visit. I authorize the release of information to my insurance company.
  • Physician Ownership Disclosure Form

  • During the course of your physician/ patient relationship with Drs Holt, Jaglowski, Higgs, Weinberg, Juarez, Muffoletto or their representatives at All American Orthopedic & Sports Medicine Institute, you may be referred to any of the following: Alliance MRI - 17490 Hwy 3, Webster, TX 77598 * Houston Physicians Hospital - 333 N Texas Ave #1000, Webster, TX 77598
  • Any of these facilities may be out of network with your healthcare provider. You have the right to choose alternate healthcare providers. You will not be treated any differently by your Physician, the Physician's staff, or the facility. A list of specific Physician ownership and Physicians immediate family members ownership is available upon request. This information is being provided to you to help you make an informed decision about your healthcare.