There’s a version of private practice that exists only on social media: custom branding, a beautiful website, a full suite of paid tools, all in place before the first client. Building that first is the most common way to delay a practice indefinitely. What you need to see a first client legally and well is shorter than most people expect.
The must-haves
An active license in the state where your client is located. A decision about structure, either a sole proprietorship or an entity your state allows for your license, and an EIN. A business bank account. Professional liability insurance. An individual NPI from NPPES, which you’ll need for insurance and for many superbills. An informed consent document. A notice of privacy practices. A Good Faith Estimate process for self-pay clients under the No Surprises Act. A secure way to keep records and, if you see clients remotely, a telehealth platform that will sign a business associate agreement. And a way to get paid.
That list covers the legal floor and the operational basics. Everything on it either protects you, protects the client, or is required to get paid.
The nice-to-haves
A full website, a logo, paid marketing, an elaborate EHR with every module turned on, a group practice structure, a specialty certification you’ve been meaning to finish. All of these can help later. None of them is a prerequisite for your first session.
The traps
Two purchases trip up new practices most often. The first is an expensive, feature-heavy EHR bought before you have clients, locked into an annual contract. Most offer monthly plans and free trials, and a simpler system is easy to outgrow later. The second is paying for brand work before you know your niche. A brand built around a population you end up not serving is money spent twice.
What it costs
A lean solo telehealth practice typically spends a modest sum on formation, insurance, records, telehealth, and filings in its first year, and the range depends heavily on your state’s filing fees and which tools you choose. Running your own numbers is more useful than any average: the caseload calculator includes a startup costs view built for exactly this.