Online Forms

We offer our paperwork on line so you can complete it in the convenience of your own home. 


Patient Information #1

  Download & Print Form


Patient Information #2

  Download & Print Form


New Patients Questionaire #1

  Download & Print Form


New Patients Questionaire #2.

  Download & Print Form


Financial Agreement

  Download & Print Form


Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.


If you have any questions, just call our knowledgable staff.




Rapha Clinic Sterling
United Bank Building
21036 Triple Seven Road,
2nd Floor,
Sterling, Virginia
703.444.4030
Rapha Clinic Arlington
Rosslyn Metro Center
1700 N. Moore Street,
Suite 380,
Arlington, Virginia
703.816.5900
Rapha Clinic Herndon
(National Chiropractic Center)
299 Herndon Parkway,
#209
Herndon, VA
(703) 787.7722

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Rapha Clinic Asks some important questions of interest to Sterling residents - Chiropractor Sterling Rapha Clinic Asks...

What's the difference between chiropractic and medicine?
Medical treatment focuses on the disease or the symptom. Chiropractic focuses on the person with the disease or the symptom. Medical treatment usually involves changing blood chemistry. Chiropractic involves restoring nervous system integrity. Medical doctors prescribe medicine. Chiropractors adjust the spine—a common source of nervous system interference.
How does headache medication find the headache?
It can't! Chiropractors know that when you ingest a drug and it enters your bloodstream it numbs or deadens your entire body. Chiropractic adjustments, on the other hand, are specific, targeted and delivered with precision.