We have been making printable pages with CSS now. Our data is HIPAA protected so I can’t send it to external sites like DocRaptor. The wrapper component allows you to set the width to fit on a page. The panel set allows you to add a header with an image and page title etc. More wrappers allow you to set up lines and other stylistic elements. When someone wants to print we have a button they click that opens up the page with no Salesforce Header and stylized to look like a printable page. You can use CSS to set up page breaks. We have been able to get some pretty nice pages. It would still be nice if those pages could be automatically converted to PDF. But for now, the end user just clicks Ctrl-P and uses the print dialog box. I am also looking at Prince XML since you can host that on internal servers.
