> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Startup cost worksheet

> A structure for the launch budget — deliberately a worksheet, not a table of average costs, because variance between specialties swamps any average.

A structure for the launch budget. Deliberately a worksheet, not a table of "average costs": published averages are mostly lender and consultant marketing, and variance between specialties swamps any average. Fill it in with real quotes. The categories are what practices get wrong.

```mermaid theme={null}
pie title Typical de novo budget shape (procedural specialty)
    "Build-out" : 40
    "Equipment + technology" : 25
    "Working capital (6 months)" : 25
    "Professional + admin" : 10
```

## Build-out and space

Design fees, construction (clinical plumbing, electrical, shielding), permits, signage, furniture, deposits. Offset by the negotiated TI allowance. Get local per-square-foot quotes; clinical space costs a large multiple of office space.

## Equipment and technology

Clinical equipment (new vs. refurbished is a real decision), sterilization, IT, phones, and the software stack: [EHR/PM](/guides/choose-your-ehr) implementation plus first-year subscription, clearinghouse, website. Equipment financing often runs separately at equipment-secured rates.

## Professional and administrative

Attorney, CPA, credentialing service (per provider), licenses, malpractice (claims-made starts cheap and steps up), business insurance, pre-opening marketing.

## The line everyone undersizes: working capital

Six months of full operating expenses **including your own draw**, covering the [credentialing gap](/guides/get-credentialed) plus A/R lag. Formula: (rent + payroll + loan service + insurance + supplies + software + owner draw) × 6. If the total makes the project uncomfortable, resize the project, not the working capital. Undercapitalized launches fail on runway, not quality.

## Sanity checks before the loan application

Three tests lenders apply, so apply them first: month-12 revenue covers costs plus debt service with margin; production assumptions match your actual associate history; construction carries 10 to 15% contingency. A conservative model that closes beats an impressive one the underwriter discounts.

## Sources and uses

Practice loan for build-out and equipment ([guide](/guides/get-a-practice-loan)), equipment financing where cheaper, the TI allowance, personal liquidity for the share lenders want you to carry. Then land it all in [properly structured accounts](/start-here/03-setting-up-your-banking) from day one.