Journey
Start a physiotherapy, osteopathy or chiropractic clinic
Learning path for people starting a physiotherapy, osteopathy or chiropractic clinic. Check whether the clinic needs to register with a health regulator, choose how to trade and deal with VAT, set up your premises, check the practitioners who will treat patients, insure the clinic, protect patient records, and open safely.
Setting up a clinic of regulated practitioners
If you own a clinic staffed by physiotherapists, podiatrists, osteopaths or chiropractors, these steps follow the order in which you meet each decision. Most clinics of this kind do not register with the Care Quality Commission (CQC) for treatment, so the generic healthcare route can mislead you.
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Check whether your clinic needs to register
List who will treat patients and which services you will offer, then check them against the registration triggers. A nurse, doctor or paramedic on the team, some imaging or foot surgery, or a listed service in Wales or Northern Ireland can change the answer. Do this before you spend money on premises.
Physiotherapy, osteopathy and chiropractic clinic registration
Check your team and services against the registration triggers in England, Scotland, Wales and Northern Ireland.
Set up and run a regulated health practice
Use this only if the check shows your clinic must register with the CQC.
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Choose how to trade and deal with VAT
Treatment by a registered practitioner is usually VAT-exempt, which changes how you read the generic VAT guidance. Read the exemption guide before you decide whether to register for VAT. Settle your business structure at the same time, because it affects your tax and your liability.
Sole trader or limited company
Compare the structures and choose the one that fits your plans.
Set up a limited company
Use this if you choose to trade through a company.
Register for Self Assessment
Use this if you will trade as a sole trader or partner.
VAT on physiotherapy, osteopathy and chiropractic treatment
See which of your fees are exempt and what the exemption means for registration and for VAT on your costs.
VAT registration
Use this if the clinic will also make taxable sales, such as products.
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Sort out your premises
Treatment rooms bring fire safety duties from the day you open. Further checks depend on your plans. Some London boroughs license special treatments, and a clinic that takes X-rays must register its equipment with the Health and Safety Executive (HSE) before the first X-ray.
Renting your first business premises
Check the lease terms before you commit to a room.
Understanding business rates
Find out how rates apply to the premises you choose.
Fire safety requirements for business premises
Your duties for a fire risk assessment and fire precautions.
Nails and massage licences from your council
Check whether your council licenses special treatments, which matters most in London.
Register and run X-ray equipment in a chiropractic clinic
Use this only if you will take X-rays. It covers HSE registration, a radiation protection adviser and written procedures.
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Bring in practitioners
You can treat patients yourself, employ practitioners or let rooms to self-employed ones. Each route changes who holds the indemnity cover, who counts as the employer and which checks apply. Titles such as physiotherapist, osteopath and chiropractor are protected, so check the register before anyone treats a patient.
Check practitioners before they treat in your clinic
Check the register, confirm indemnity cover and ask for the right DBS check.
Employment status
Work out whether each practitioner is an employee, a worker or self-employed.
Self-employed status if you rent a chair or room in a salon
Use this if you let rooms to self-employed practitioners. It is written for salons, so read the tax and VAT points as a guide to the same questions for clinic rooms.
Before you hire your first employee
What to prepare before an employed practitioner starts.
DBS checks for employers
Check types, fees and how to apply for a check.
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Insure the clinic
Osteopaths and chiropractors must hold a minimum level of indemnity cover. Other practitioners must hold cover that suits their practice. Employers' liability insurance is a legal requirement once you employ anyone.
Professional indemnity insurance
Choose cover that matches the treatment you provide.
Employers' liability insurance
Find out who must be covered and what happens if you are not.
Business insurance: what you need
See the other cover a clinic usually needs, such as public liability.
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Protect patient records and advertise honestly
Patient records are special category data, and how long you keep them differs by profession. The Advertising Standards Authority (ASA) polices advertising claims about treatment. Settle your records and your first website or leaflet before you take bookings.
Healthcare data protection
How to handle patient data under data protection law.
Register with the ICO
Register and pay the data protection fee.
Advertise a physiotherapy, osteopathy or chiropractic clinic
What a first website or leaflet can claim about treatment.
Deposits, cancellation fees and no-show charges
Set a fair cancellation policy for appointments.
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Open and run safely
Health and safety and infection control apply from the first appointment. Clinical waste needs separate handling where you use needles, as in acupuncture or dry needling.
Health and safety for small businesses
Your duties for risk assessment, training and accident records.
Infection prevention and control for healthcare providers
Written for CQC-registered providers. If your clinic is not registered, read it for good practice.
Dispose of hazardous waste
Use this if you use needles or produce other hazardous waste.
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Check you are ready
Before your first patient, confirm that the registration check still holds and that every practitioner has passed the register check. Repeat these checks whenever you add a service, a profession or a practitioner.
Physiotherapy, osteopathy and chiropractic clinic registration
Repeat the registration check when your services or team change.
Check practitioners before they treat in your clinic
Repeat the register, indemnity and DBS checks for each new practitioner.