Starting a cash-based practice can feel exciting, but also overwhelming. Without the framework of insurance, you’ll need to set up your own systems, market your services, and communicate your value to families. The good news? When you break it down step by step, the process becomes much more manageable. This Cash-Based Business Starter Checklist will guide you through the essentials so you can start strong. If you’re still unsure whether this model fits your goals, take a look at Is a Cash-Based Practice Right for You?

Step 1: Clarify Your Services

One of the biggest advantages of a cash-based model is the freedom to offer the services you’re most passionate about. Unlike insurance, which often restricts what’s billable, a cash-based approach lets you design sessions that meet real client needs.

• Start by listing exactly what you want to offer: individual therapy, small groups, parent consults, or online coaching sessions.
• Identify one or two specialties that could set you apart. For example, do families often ask you about feeding therapy, handwriting help, or executive function coaching? That could become your signature service.
• Think creatively. Many therapists successfully branch out into workshops, school consults, or even digital products. For more inspiration, check out 25 Side Hustles for Therapists.

Step 2: Understand Your Local Market

Before you set your rates, it’s essential to understand your community.

• Research what other private-pay providers in your area are charging. Rates vary widely based on geography, so knowing your local benchmarks helps.
• Define your ideal clients. Are you hoping to serve young children, teens, or even adults? Will you target families, schools, or community programs?
• Study your competition. Instead of worrying about who’s already out there, think about what makes you different. That might be your specialty, your background, or even the convenience of offering online sessions.

Step 3: Get Your Foundations in Place

A cash-based practice is still a business—and that means having the right structure and protections.

• Choose your business structure, such as LLC or sole proprietorship, based on your state’s requirements.
• Check that your malpractice insurance covers private, cash-based work. Sometimes you’ll need an add-on or a different policy.
• Set up a secure way to collect payments. Many therapists use platforms like Square, Stripe, or PayPal, but you can also consider invoicing software for a more professional system.

Having these basics in place not only protects you, but also builds trust with families.

Step 4: Set Up Your Marketing Basics

Marketing can feel intimidating, but it doesn’t have to be complicated. At its core, it’s about making sure the right people know who you are, what you do, and how you can help.

• Write a clear “Services” page or one-page flyer that outlines your offerings in family-friendly language.
• Create a simple website, or at minimum, establish a professional profile where families can find you.
• Draft a short introduction you can use when connecting with schools, pediatricians, or community leaders.

Read more about How to Grow Your Practice shares strategies to build visibility without feeling salesy.

Step 5: Plan for a Smooth Client Experience

Families choosing private pay are often looking for a streamlined, professional experience. Think about how you can make every step feel clear and easy.

• Provide a superbill template so families can submit for possible insurance reimbursement.
• Develop straightforward intake forms and consent agreements. Keep them simple but thorough.
• Decide how you’ll track sessions, goals, and payments. Even a basic spreadsheet can work at first, though many therapists use EMR or practice management tools.

A smooth onboarding process builds trust and encourages word-of-mouth referrals.

Step 6: Build Your Safety Net

Starting a cash-based practice takes time to grow. A safety net can make the transition less stressful.

• Aim to set aside 3–6 months of savings if possible. If that’s not realistic, consider keeping part-time employment while you build your caseload.
• Start small, perhaps a few private clients in the evenings or one group program on weekends.
• Hold onto your current insurance-based or school contracts until your private practice income feels steady enough to stand alone.

This gradual approach allows you to test your model, refine your systems, and build confidence without risking financial strain.

Launching a cash-based practice doesn’t mean reinventing the wheel. It’s about clarity, preparation, and taking consistent steps forward. With a clear vision, solid foundations, and a safety net in place, you can build a business that aligns with your values and supports the families you serve. And remember: you don’t have to do everything at once. Start with one step from this checklist and build from there.

✅ Cash-Based Business Starter Checklist

Step 1: Clarify Your Services

• List services (therapy, groups, workshops, online, etc.)
• Identify 1–2 niche specialties
• Explore creative offerings (consults, trainings, digital products)

Step 2: Understand Your Local Market

• Research local private-pay rates
• Define your ideal clients
• Note competitors and your unique value

Step 3: Get Your Foundations in Place

• Choose your business structure
• Confirm malpractice insurance coverage
• Set up secure payment systems

Step 4: Set Up Your Marketing Basics

• Write clear service descriptions
• Build a simple website or profile
• Draft an introduction for networking

Step 5: Plan for a Smooth Client Experience

• Create a superbill template
• Develop intake and consent forms
• Choose a system for tracking sessions/payments

Step 6: Build Your Safety Net

• Save 3–6 months of expenses or keep part-time work
• Start small with a few clients or one group program
• Maintain current contracts until caseload grows