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How to Open a Medspa: The Entrepreneur's Checklist

Learn about the different requirements you’ll need to meet before opening a medspa

If you’re a self-care enthusiast and entrepreneur wondering how to open a medspa — you’re not alone. The medical spa business is booming. In fact, the industry is worth around $5.4 billion in the US and is expected to grow to $25.9 billion globally by 2026. However, because medspas provide health services, opening one can be a bit complicated. Before drawing up a business plan or making any commitments, be sure you’ve reviewed these requirements, taking special notes of any location-specific restrictions. 

Understanding ownership requirements for medspas

In most states, you can’t run a medical spa unless you’re a licensed physician. That’s because services provided by medspas, like injectables, skin treatments, and laser treatments, are legally classified as medical procedures and must be performed either by or under the close supervision of a licensed medical doctor. In most of the US, corporations are prohibited from practicing medicine or hiring a doctor to practice medicine on their behalf. This is done to protect patients and prevent a conflict of interest in the client-patient relationship (the doctor is obligated to do what’s best for the patient, regardless of financial incentives). 

That means you’ll need an ‘MD’ after your name to own a medspa in most places, but there are exceptions. In Alaska and Florida, a medspa doesn’t need to be owned by a medical professional, but the practice must be supervised by a physician. In Florida’s case, a non-physician cannot accept payment for medical services, even if they are listed as the owner. In some states, like New York and Minnesota, a nurse practitioner can own a medspa as long as they operate under the supervision of a medical doctor.

Working with a medspa business if you’re not a doctor

A non-physician can assist with operating a medspa through a management service organization (MSO). Here’s how that works:

  1. You sign a management service agreement (MSA) with a licensed medical doctor. The doctor is the legal owner and you agree to perform certain services for them, for which they pay you as a vendor.

  2. The doctor supervises, performs, and makes decisions about the medical procedures provided at the medspa.

  3. You manage operations like payroll, bookkeeping, human resources, and marketing.

It’s a good idea to talk to a legal professional before establishing an MSO to make sure everything is above reproach in your business arrangement.

Want to learn more about medspa ownership requirements? Read Who Can Own a Medical Spa? The Degrees and Licenses You Need to Get Started.

Additional licensing requirements to consider


Since medspas perform medical services and handle protected health information (PHI), you will need to comply with HIPAA (Health Insurance Portability and Accountability Act) regulations at your practice. Go through a compliance checklist with your lawyer to figure out how to secure your clients’ information. For example, you may need to: 

  • Create policies around collecting and storing PHI, both the physical copies in a filing cabinet and any information you gather digitally.

  • Train employees on following these policies.

  • Do periodic audits to make sure you are remaining compliant.

HIPAA fines are infamously high, on average ranging from $100 to $50,000 per violation; in some cases, criminal charges may also be involved. In other words, don’t overlook this part of your business!


Medspas need to be especially vigilant with Occupational Safety and Health Administration (OSHA) regulations because medspa employees can be exposed to bloodborne pathogens and other biohazards. You’ll need to develop detailed protocols for disposal of items like syringes and gloves, as well as extensive cleaning procedures for your staff. The OSHA website has a compliance checklist you can follow to audit your business. As with HIPAA, OSHA violations come with stiff penalties.

Insurance requirements

You’ll need a few different types of insurance for your medspa:

  • General liability: Covers costs related to accidents, including medical expenses and property damage

  • Medical malpractice: Covers costs related to malpractice lawsuits and disputes

  • Workers’ compensation insurance: Covers lost wages and medical expenses for employees injured in a workplace incident

Medspas and tipping

One key difference between medspas and other self-care businesses like salons and barbershops is their approach to tipping. Because medspas are staffed by medically trained staff and provide (at least in the eyes of the law) medical services, tipping is discouraged in some states and illegal in others. It’s an ethically gray area for healthcare professionals to accept tips, and in some states, a gratuity can be seen as a kickback fee, which can lead to a medical board review and a revoked medical license. To be safe, it’s best to clearly communicate to clients and staff that tipping is not allowed. 

For more information on medical spa requirements and regulations, read Medical Spa Requirements and Regulations to Know Before Opening Your Business.

How to open a medspa when qualifications vary by state 

Each state has slightly different requirements for medical spas. A few states with especially strict requirements are listed below, but you should do careful research and consult with a legal professional in your area before opening a practice. 

Medspa requirements in California

  • Medspas can only be owned by a licensed physician.

  • Medspas have to operate as professional corporations (cannot be LLCs).

  • All treatments classified as medical services must be performed by a licensed physician; or a registered nurse or a physician assistant under the supervision of a licensed physician.

  • Licensed aestheticians and cosmeticians can perform microdermabrasion on the surface level of the skin.

Medspa requirements in Illinois

  • Medspas can only be owned by a licensed physician.

  • Physician must examine the patient before any medical service (including laser treatments) can be administered.

  • Medical services like liposuction, colonics, and injections must be administered by a licensed physician or a cosmetologist assistant under physician supervision.

Medspa requirements in Texas 

  • Medspas can only be owned by a licensed physician.

  • Medspas need to get an operator’s certificate from the Texas Secretary of State, which allows them to be listed on its website.

  • A licensed physician or a physician assistant needs to examine the client before a medical service and prescribe a treatment plan.

  • Physicians can’t delegate treatment to estheticians and estheticians can’t perform laser treatments.

Medspa requirements in Pennsylvania

  • Medspas can only be owned by a licensed physician.

  • A licensed physician, advanced practice registered nurse (APRN), or physician assistant needs to examine the client before ordering a treatment.

  • Doctors, APRNs, registered nurses, or physician assistants need to perform all medical services.

Medspa requirements in Florida

  • Anyone can own a medical spa, but it must have a supervising physician. 

  • The physician can only supervise one location outside their primary practice, and the location has to be within 75 miles of their primary practice and submitted to the Florida Board of Medicine.

  • Laser or light-based services must be performed by an MD or physician assistant under the supervision of a physician or by a nurse practitioner (NP) under a protocol signed by a physician. An electrologist license is required.

  • Physician assistants and nurse practitioners can order and administer injections like Botox under protocols reviewed by a doctor.

Medspa requirements in Georgia

  • It’s complicated: Technically only physicians can own a medspa but the responsible governing body — Georgia Composite Medical Board — has never stopped a non-medical practitioner from owning a medspa.

  • A licensed physician has to perform medical services but can also supervise or delegate to a physician assistant or a nurse.

  • Assistant laser practitioners can perform cosmetic laser services like hair removal without supervision, but other laser services must be done under the on-site supervision of a physician.

  • APRNs can own medspas but cannot hire physicians to supervise their practice.

For more details on medspa requirements in different states, read How to Open a Medical Spa in Your State.

Purchasing medspa equipment

A significant part of figuring out how to open a medspa is deciding on the tools you’ll purchase. The type of equipment you’ll need will depend on your service menu. If you’re focusing on microdermabrasion treatments, for instance, your equipment needs will be very different from a medspa that specializes in cryotherapy. You’ll also need to think about your budget and how many items on your list you can purchase right away. If you’re working with smaller capital, it’s fine to have a “someday” wishlist as long as you’ve stocked the basics by opening day. 

Some must-have essentials for medspas include:

  • Facial beds and chairs: Every medspa will need at least a few medical spa chairs. Focus on client comfort, durability, and quality of materials, as well as how well the chair can adjust to different positions.

  • Injection tools: Syringes, vein finders, cannulas, gloves, and other injection tools are essential if you plan to offer Botox, Dysport, Platelet-rich plasma (PRP), or Platelet-rich fibrin (PRF) injections. Keep in mind that sterile equipment has an expiration date, so avoid over-purchasing.

  • Decor: Thoughtful touches like candles, essential oil burners, good lighting, and art make your medspa more inviting and less clinical.

  • Medical spa software:  Give your clients and employees the gift of seamless online booking while you track sales and run marketing campaigns with comprehensive, user-friendly medspa software. For example, Boulevard customers can automatically schedule follow-up app appointments with clients and securely store treatment notes within our HIPAA-compliant platform. 

Learn more about equipment for medspas in How to Find the Right Medspa Equipment for Your New Business.

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