Dr. Erica MS Statman, B.A., D.C., D.I.C.C.P
Maimonides Chiropractic

Make an Appointment

10807 Main Street, Suite 800, Fairfax, VA 22030 | 703-383-1630

Make an Appointment

This form is for new patient exams, re-examinations, myofascial, tbm, and phone consultation appointments only.

To schedule a regular adjustment appointment, click here. 

Please enter all information. We will make every effort to accommodate your first choice, but please specify an alternate in the event that your first choice is unavailable. Your appointment is not booked until you receive a confirming email or telephone call.


Appointment type:

Patient Name(s):

E-mail address:

Daytime Telephone Number:

Home Work Cell


First Choice:

Date:

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Day & Time:



Second Choice:

Date:

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Day & Time:

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