The First 5 Things You Must Do When Starting a Physical Therapy Practice

The moment you decide to open your own physical therapy practice, two things happen simultaneously: enormous excitement, and immediate overwhelm. There are a hundred things you could do. The question is which five you should do first.

We've helped dozens of PTs launch practices, and the ones who get stuck at the starting line are almost always stuck because they're trying to do everything at once. The ones who launch quickly and confidently have a clear sequence. This is that sequence.

Step 1: Choose Your Business Model (Before Anything Else)

Everything about your practice — your legal structure, your pricing, your marketing, your location — flows from your business model. The most important question is: how are you going to get paid?

Your three options are cash-based (out-of-network), insurance-based (in-network), or hybrid. For most new PT practice owners, we strongly recommend starting cash-based or hybrid. The financial math is dramatically more favorable, the administrative burden is far lower, and you can launch weeks faster without credentialing.

Don't move to step 2 until you've made this decision. Read the full breakdown: Cash vs. Insurance vs. Hybrid: Which Model Is Right for You?

Step 2: Form Your LLC or PLLC (This Week)

Once you know your model, make your business legal. Register an LLC (or PLLC, which some states require for licensed professionals) with your state's Secretary of State. This gives you personal liability protection from day one and is the foundational legal structure for your practice.

It takes about 30 minutes online and costs $50–$200 in state filing fees. You don't need a lawyer to do this step. After your LLC is registered:

• Get a federal EIN (Employer Identification Number) from IRS.gov — free, takes 10 minutes
• Open a dedicated business checking account using your EIN
• Never mix personal and business finances again — this is one of the most common and costly mistakes new practice owners make

Full breakdown of structure options: LLC vs. S-Corp vs. Sole Proprietor: What’s Best for Your PT Practice?

Step 3: Get Malpractice Insurance (Before You See a Single Patient)

This is non-negotiable. You must have professional liability insurance in place before your first patient walks in the door — or before you go mobile to anyone's home.

The two most common providers for physical therapists are HPSO (Healthcare Providers Service Organization) and CM&F Group. Annual premiums for a solo PT run $300–$700. Policies typically provide $1 million per occurrence / $3 million aggregate coverage — more than sufficient for most solo practitioners.

If you're operating out of a physical space you lease, also get a general liability policy ($400–$700/year) to cover non-clinical incidents (slip and fall, property damage, etc.).

Step 4: Set Up Your EMR, Scheduling, and Payment Systems

Before you see your first patient, your operational infrastructure needs to be ready. Trying to set it up after you're already treating is a chaotic, avoidable mistake.

What you need before patient one:

• EMR: Jane App, WebPT, or Cliniko. Pick one, learn it, and have your note templates built before your first evaluation.
• Online scheduling: Enable patients to book directly. Eliminates back-and-forth and runs 24/7.
• Digital intake forms: Health history, consent, financial policy acknowledgment — all completed before the first appointment. Every major EMR has this built in.
• Payment processing: Stripe or Square for card payments. If you're cash-based, have your card reader or online payment link ready before day one. Collect at the time of service — always.
• Superbill template: If you're out-of-network, patients may want to submit to insurance. Set up a superbill template in your EMR.

Step 5: Tell Everyone You Know (Start Marketing Before You're Ready)

This is the step most PTs skip because it feels uncomfortable. It's also the step that gets you your first patients — which means it's the most important marketing activity you will ever do.

Before you build a website, before you run an ad, before you optimize a Google Business Profile: send a personal message to every person you know. Former patients, friends, family, gym buddies, college classmates, former coworkers. Tell them you've launched, what you do, who you help, and how they can book or refer someone.

This is not a mass email blast. This is personal outreach, one person at a time. It takes a day. It generates your first 5–15 patients from people who already like and trust you. No ad budget required.

Avoid the pitfalls that trip up most new PT practice owners right after launch: 8 Mistakes That Kill PT Practices in Year 1.

The Bonus Step: Get Your Google Business Profile Up

Once you're operational, claim and fully optimize your Google Business Profile immediately. This is free and is your single most important long-term local marketing asset. Add your address or service area, phone number, booking link, business description, and 10+ photos. Then start asking every new patient for a Google review after their first visit.

Your PT Practice Launch Checklist

1. ☐ Decide on business model (cash / hybrid / insurance)
2. ☐ Form LLC or PLLC with your state
3. ☐ Get federal EIN from IRS.gov (free)
4. ☐ Open a business bank account
5. ☐ Get malpractice insurance (HPSO or CM&F)
6. ☐ Choose and set up EMR (Jane App, WebPT, or Cliniko)
7. ☐ Enable online scheduling and digital intake
8. ☐ Set up payment processing (Stripe or Square)
9. ☐ Set your rate and build your pricing/package structure
10. ☐ Send personal outreach to your entire network
11. ☐ Claim and optimize your Google Business Profile