SCHEDULE YOUR BRACES ADJUSTMENT OR COMFORT VISIT For non-routine visits, please complete the “REASON FOR VISIT” section. HiddenAppointment TypeBRACES ADJUSTMENT (ROUTINE) The date 6 weeks from today is: HiddenDoctorDr. Zhang Appointments June 2023 Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June 5, 2023 9:00 AM 9:30 AM 10:00 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM June 6, 2023 10:00 AM 10:30 AM 11:00 AM 11:30 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 8, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 12:30 PM 1:00 PM 1:30 PM 2:30 PM 3:00 PM June 9, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM June 10, 2023 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM June 12, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM June 13, 2023 10:00 AM 10:30 AM 11:00 AM 11:30 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 15, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 16, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 17, 2023 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM June 19, 2023 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM June 20, 2023 10:00 AM 10:30 AM 11:00 AM 11:30 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 22, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 23, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 24, 2023 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM June 26, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM June 27, 2023 10:00 AM 10:30 AM 11:00 AM 11:30 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 29, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM June 30, 2023 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM PATIENT NAME* EMAIL* REASON FOR VISIT/NOTES (FOR NON-ROUTINE VISITS)