Schedule a New Patient Appointment

In order to schedule a new patient appointment, we request that you download, sign and return the form below.  Once we have your form, we will call you back to arrange the time and date.

New Patient Information and Instruction (Secure Online Form)

New Patient Information and Instruction (PDF download)

Before Your First Visit

Prior to your scheduled visit we ask you to download the comprehensive health history questionnaire. The questionnaire is 11 pages and we ask patients to allocate one hour to thoroughly complete this form. The information you provide helps Dr. Hirani properly diagnose your condition(s). The questionnaire also acts as a skeleton for the detailed history that she will obtain from you during your initial visit. You may wish contact your other care providers to request copies of labwork or imaging you wish Dr. Hirani to review.

New Patient Forms

Please complete the following forms prior to your appointment and bring them with you on the day of your visit. Having your forms completed in advance will maximize your time with Dr. Hirani. There will be a few other forms for you to review and sign at your initial consultation.

Health History Questionnaire for Adults (PDF)
Health History Questionnaire for ASD Children (PDF)

Patient Portal

Existing patients communicate with Dr. Hirani through secure patient portal.  Please follow the directions in the welcome email for current or new patients.

Contact Us

Hirani Wellness Medical Center
Karima Hirani, MD MPH
9736 Venice Blvd.
Culver City, CA 90232
Map & Directions

Phone: (310) 559-6634
Fax: (310) 559-6652

Send E-mail