Starting a private practice is one of the most rewarding moves a therapist can make: you set your hours, choose your clients, and keep what you earn. It’s also a lot of small decisions. This checklist lays them out in a sensible order so you can move steadily instead of spinning. Adapt it to your state and specialty — and when in doubt on legal or tax questions, talk to a professional.
1. Get your licensing and credentials in order
- Confirm your license is active and in good standing in the state where clients are located.
- Understand any supervision requirements if you’re pre-licensed or recently licensed.
- Decide whether you’ll be private-pay, take insurance, or both (this shapes a lot of later steps).
2. Set up the business
Choose a structure
Many solo therapists operate as an LLC or PLLC for liability separation, but the right choice depends on your state and tax situation — a quick consult with an accountant is worth it here.
Handle the essentials
- Register the business and get an EIN (so you’re not using your SSN on forms).
- Open a separate business bank account — never mix personal and practice money.
- Get professional liability (malpractice) insurance.
- Look into a general liability policy if you’ll have an office.
3. Decide on your space
Office, fully virtual, or hybrid? Telehealth lowers startup costs dramatically and widens your geographic reach within your licensed state. Many new practices start virtual or hybrid and add office hours later once cash flow is steady. If you go virtual, make sure your telehealth is set up compliantly (see our HIPAA telehealth guide).
4. Get HIPAA-compliant from day one
It’s far easier to start compliant than to retrofit later. At minimum you’ll want:
- Practice software with encryption, access controls, and a signed Business Associate Agreement (BAA).
- A plan to keep PHI out of regular email and texts.
- Intake and consent forms, including a telehealth consent if you’ll work virtually.
- Basic policies: privacy practices, record retention, and a release-of-information process.
5. Choose your practice software
This is the operational backbone — scheduling, notes, telehealth, intake, and billing. As a new solo practice, look for something that includes the essentials without clinic-sized pricing or per-feature add-ons. Avoid overbuying: you can always move up if you grow into a group. Our buyer’s guide for solo therapists breaks down what to prioritize and what to skip.
6. Set your fees and payment process
- Research typical rates for your license and area; price for sustainability, not just to compete.
- Decide your cancellation and no-show policy before your first client (see our no-show guide).
- Set up simple card payments so getting paid is never awkward or manual.
- If you’re private-pay, consider offering superbills for clients seeking out-of-network reimbursement.
7. Build a simple online presence
- A clean one-page website with your specialties, approach, and how to book.
- A profile on a therapist directory or two where clients in your area search.
- Clear contact and a low-friction way to request a first appointment.
8. Get your first clients
Referrals are the lifeblood of a new practice. Let your professional network know you’re accepting clients, connect with local providers (physicians, other therapists with waitlists), and make sure anyone who finds you can book easily. Early momentum compounds: a smooth first experience turns one client into referrals.
A realistic first-90-days sequence
- Weeks 1–3: license check, business structure, EIN, bank account, malpractice insurance.
- Weeks 3–6: choose software, set up HIPAA basics, intake/consent forms, fees and policies.
- Weeks 5–8: website + directory profiles, payment setup, telehealth tested.
- Weeks 7–12: tell your network, take first clients, refine your process as you go.
You don’t have to get everything perfect
The therapists who launch successfully aren’t the ones who plan forever — they’re the ones who get the essentials right and start seeing clients. Set up a compliant, simple foundation, then improve as you learn what your practice actually needs.
When you’re ready for the software piece, Theraflow gives you the whole operational toolkit in one place — free to try for 14 days, no setup fee.
Related reading: Best practice management software for solo therapists and How much does therapy software cost?.