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 2022 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 28, 2022 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 3:30 PM June 30, 2022 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 3:30 PM 4:00 PM PATIENT NAME* EMAIL* REASON FOR VISIT/NOTES (FOR NON-ROUTINE VISITS)