How Much Does it Cost to Start a Nutrition Practice

Setting the Stage

As some of you know, I am getting ready to re-launch my private practice after a multi-year break. If you can call years spent raising very small children a break, which in my opinion you cannot :). In any case, I'm excited to jump back in.

What's less exciting is re-starting from scratch.

No pieces of my old practice remain, other than what I learned from so many years of working with clients. The logistics, though, the bits and pieces and forms and all of that? I needed to start ALL over. 

I thought I'd write up the process in case it's helpful to other people who may be starting over or even starting up for the very first time. I know it can be hard to anticipate all of the things that need to happen and how much things will cost. 

Am I missing anything? Probably. I'm definitely not an expert in this, so please don't read this as a manual but rather as my attempt to detail one person's "getting started" process.


Business Set-Up

My least favorite part. Except for taxes, maybe? Still it's not that painful if you just go through the steps and start early.  Here's what I did. The order is important here. 

  1. 1
    Get a Registered Agent: You don't need this if you don't mind having your home address published everywhere or if you have a business address where you will be accessible during business hours for legal purposes. I do mind and I do not have regular business hours, so I wanted an RA. In Virginia, you can get a registered agent for $49 per year via Virginia Registered Agent, which is what I did. Note that this is significantly cheaper than what is offered via LegalZoom. Shop around! 
  2. 2
    Form an LLC: You can stick with sole proprietorship, but the LLC option provides a bit more legal protection so that's what I opted for.  In Virginia, you can do this online or mail in a paper copy; either way it costs $100. Note that when you fill in the online form, it automatically creates your articles of incorporation, so you don't need to pay someone to do this for you necessarily.  Filing this online and getting the forms electronically took < 15 minutes. You do need to list your Registered Agent when you set up your LLC, so be sure to do step 1 first if you're going to use one.
  3. 3
    Get an EIN: This is like a social security number for your business. You need to have your LLC paperwork filed first. It's free but you can only file for one online during business hours. Again, some places will charge money to help you with this, but it's super easy.
  4. 4
    Make an Operating Agreement and get it notarized: You can pay a lawyer to draft your operating agreement, but if you have a single-member LLC and things are uncomplicated, you can Google "[your state] operating agreement template" and find a lot of options that are easy to adjust for your situation. I had mine notarized for free at the bank when I went to set up my business checking account. You can also get things notarized at the public library or many UPS stores for a small fee ($3-5).
  5. 5
    Get a separate business bank account: You definitely need one of these. Do not mix personal and business funds. I went with a local credit union that has no fees and great service. You will need your EIN, operating agreement and LLC paperwork to open one. Call ahead and make sure you have the specific documents that they will need. It took about an hour to get this set up in my case.
  6. 6
    Set up Accounting Software: This is not madatory, but you do need some kind of plan to manage your finances, particularly since you will need to start filing quarterly taxes as soon as you start making money. I use Wave, which is a free tool that integrates with your bank account. Other paid programs that are popular with small businesses are FreshBooks (great if you need invoicing) and QuickBooks (more complicated than FreshBooks).
  7. 7
    Outstanding Tasks: I still need to get a home occupancy permit and register with the Clerk of the City Court to get a local business permit ($50 for home occupancy permit and $30 estimated city taxes 2019). Then this part will be over-ish. 

Website Set-Up

mortar and pestle with basil leaves

For marketing and web design, I am starting out as simple as I possibly can. I don't want to spend a ton of money on web design, logo design, etc so I'm just using what I already have to do the best I can. When my practice starts bringing in money I may choose to upgrade; for now, I'm aiming for good enough! 

  1. 1
    Buy domain name and hosting: Rockaway Hosting (I actually currently use their sister company Reclaim Hosting for this website and my new one, which is extremely inexpensive and designed for academics; I will be switching over to Rockaway for my practice website shortly as they are geared toward commercial sites.) It's a little more expensive than BlueHost or similar, but the service is awesome and I like to support smaller companies where I can. Cost: $120/year
  2. 2
    SiteTheme/Design: I like WordPress sites for their flexibility and control. I use Thrive Themes and do the site design myself. Even though I have VERY limited skills, I feel like I can get my point across and help people find me. Thrive Themes are super easy to use and I find that the cost is worth it in time savings. Cost: $120/year (I have a grandfathered price from several years ago; I think it's higher now.) 

Practice Management

Image by DarkWorkX on Pixabay

Here's where things get fun :). I previewed a bunch of different practice management tools. I do not currently have an office location; I will be seeing clients from a distance via phone or online so it's important to me to have something that is streamlined, secure, and easy-to-manage. I am so impressed with how far practice management software has come since I was last in practice. It's amazing! Here's what I ended up with: 

  1. 1
    Practice Better: Overall practice management software for a very affordable price. Some of the features that sold me on Practice Better are the secure video conferencing software, easy to create forms that integrate with client files,  customizable food logs, and the ability to run courses. The monthly cost is about $34 for up to 100 clients or $49 for unlimited clients. I'm starting off at the $34 level and will upgrade as needed. I'll do a separate post soon on why I like it so much. (Note that the link above is a referral link!)
  2. 2
    MailerLite: I'm using MailerLite as my mailing list software because it's inexpensive and looks to be easy to use. I'm starting a totally separate email list for my practice, so I'll be starting from 0. (Want to sign up? You could be my first subscriber!). It's free for up to 1000 subscribers and $15/month for 1,001-2500 subscribers. (The link above is also a referral link.) 
  3. 3
    Zapier: I needed to set up a Zapier account to connect Practice Better to my mailing list. This means that when clients are created in Practice Better they will automatically be added to my practice mailing list. This is free, but did take about 30 minutes worth of twiddling on the computer. 
  4. 4
    Stripe: Practice Better Integrates with Stripe, which means this is where money will be deposited when clients pay. It was easy to set up after I created a free Stripe account. There is no charge to set up the account; the fee per use is 2.9% + 30c per transaction. 
  5. 5
    Fullscript: Practice Better integrates with Fullscript for product recommendations. They have the option to provide supplements to clients at cost or with an upcharge. I prefer to provide supplements at cost, so that's what I'll be doing. I still need to go through and add my preferred products and figure out what they do/don't offer. This will definitely be easier than sending people Amazon links or hoping that their local health food store carries something reasonable. Fullscript does need to verify your license/credentials, which takes a few days. After getting that account set up it was easy to connect with Practice Better.
  6. 6
    HPSO: I use HPSO for liability insurance. They also offer a rider for consulting/education. Since I'll be offering online courses, I will add this on. Cost: $167/year for standard policy + education rider.
    UPDATE: I am now using Proliability instead of HPSO. HPSO wanted to charge a great deal extra - more than double the cost listed above! -  to cover telehealth and to list my LLC as an insured, while Proliability included both of these items as well as an endorsement covering consulting/education for a total of $149/year. I spoke on the phone with representatives from both companies and found that Proliability won out in this category as well, hand's down.  

increasing rates money

What's the Total Cost? 

The cost of everything above for one year (assuming my mailing list does not get > 1,001 and that I stay at the lower tier for Practice Better): $​1026.  This comes out to $85.50 per month, in case you're wondering. 

If I Wanted to Cut Down on Costs:

I could use BlueHost for web hosting and design (~$4/month for the first year), and I could use a cheaper WordPress theme (say one that costs $50 once). If I did these things, the cost would be closer to $​884 for the first year of business. 

While it is a lot of money up front, compared to most small businesses the startup costs are minuscule. As my business grows, I'll have money to reinvest into reaching more people, having a more polished website/logo/etc., offering additional courses, and all that. 


What is NOT on this List?

  • Education: The accounting above doesn't include the 8+ years of higher education that I'm building on when I see clients. It wasn't free 😉
  • Marketing: I didn't pay anyone to do my logo, web design, etc. I picked a font  and then used Canva to write my name in that font. I found a color scheme I liked on Design Seeds and then used those colors in my website/logo. I may eventually upgrade; for now, this works!
  • Licensing: The one thing I did have going in was my nutrition license, which I have fortunately kept up with when my practice was on hiatus. Fees vary by state; in Maryland, it costs $250 every 2 years.  My Registered Herbalist credential through the AHG is $150 per year as well.
  • NPI: Even if you won't be billing insurance, you still need an NPI so that you can provide superbills for clients who want to file for reimbursement or apply HSA funds. I already had an NPI from my previous practice; you can apply for one here if you are licensed. 
  • Continuing Education: There are plenty of free options for CEUs, so I didn't budget for this.
  • Professional Help: I'd like to set up a meeting with a lawyer to go over my informed consent and terms/conditions forms, as well as a meeting with an accountant to make sure I'm keeping my books properly and know what to do at tax time. Not sure how much this will cost. Do I want to know? Sigh. If you have a lawyer to recommend, or know of an alternative, let me know!
  • Physical Space: I won't have a physical office where I'm seeing clients, so I don't have things like rent, electricity, printing, etc. 

Am I Missing Anything? 

Those of you who have been in practice for a while, let me know if I've overlooked anything. (Part of me wants to know and part of me wants to just be done :). 

Seriously, though, if you have tools, advice or recommendations for people starting their practices, put them in the comments or send me a message and I'll keep adding. It's hard enough to get started, so more voices and more support is a great thing. 

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Camille

Hi there. I'm Camille. I'm a professor at the Maryland University of Integrative Health, where I teach physiology and pathophysiology. I'm also a licensed nutritionist and herbalist, specializing in fertility and reproductive health. Lastly but not leastly, I'm a mom, a gardener and a pretty horrible housekeeper.

  • Thank you Camille! Even though I have an active practice looks like I missed a few steps! Appreciate the tips!

    • Camille says:

      Hi Charlene! You are very welcome. I know – there are just so many steps. It took me several years to get through all of this the first time around (!)

  • Much continued success to you, Camille! Marketing expenses such as belonging to networking groups (Chamber of Commerce, etc.) and online advertising with Google, etc., can be very pricey. Finding groups to network within without appearing sales-y requires research and finesse.

    • Camille says:

      Thanks so much, Laura. Great point about marketing, either online or in person. It’s definitely not my favorite part of being in practice, which tells me I have some work to do on changing the way I’m thinking about it 😉

  • Cathleen Agler says:

    Thank you for sharing all of this, Camille!! I truly appreciate it! I will be subscribing to your email list and following along. Best of luck on your relaunch!

    Cathleen : )

  • Vicki Stevens says:

    Thank you so much for sharing this information, Camille! And very best wishes on your relaunch. 🙂

    • Camille says:

      Vicki, somehow I missed your comment until now. You are so very welcome! I just updated the numbers a bit due to choosing a different insurance provider, in case that is of interest 🙂

  • Shira Lerner says:

    Camille, you’re awesome! I just finished requirements for the BCNS, and as a mom of young kids, am so scared to start my own practice! Thanks for outlining the steps- while it’s still daunting, it definitely seems do-able. Rooting for you and will be following your journey!

    • Camille says:

      Thanks, Shira! So glad it was helpful <3. I know it's hard to take the leap, especially with little ones at home. Let me know if I can help & good luck!!

  • Pamela says:

    This was a great blog post, Camille! I’ve been in practice for about 2 years and it’s a never-ending journey of learning! The point that stood out the most – The registered agent. What I pay yearly is expensive compared to what you mentioned so I’m researching for a reputable organization that fits my budget.

    Overall, thank you for the helpful information, but more importantly, congratulations on the re-launch of your business. I wish you great success always.

    • Camille says:

      Thanks so much, Pamela! Yes, I was *this* close to going with a registered agent option that was 3x as expensive, and fortunately I decided to do a bit of Googling. I had no idea there would be such variation.

  • Great article Camille! When I was in practice I used several scheduling softwares over the year but ended up really loving Acuity. I had it set up so that people could schedule their appointments, get signed up on my list, fill out their intake, and sign their disclaimer all on their own. Sounds like Practice Better fills that role and more. Having those services makes such a huge difference in ease for the client as well as ease for the practitioner!

    • Camille says:

      Hey Rosalee! Thanks so much for commenting. Acuity sounds like a great option for people who have a mostly in-person practice. I know not everyone wants or needs something like Practice Better. It’s great to have options and to have a personal recommendation for Acuity :).

  • This is an extremely helpful article Camille. Thank you!! Congratulations on the re-launch of your business!

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