How to Start a Nutrition Private Practice- Checklist and Cost Breakdown

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I'm thrilled to talk about this with you guys.

It's a hugely important topic, and there aren't a lot of (free) resources out there to help guide you through the process!

Here's how it usually goes...

You’ve finally completed all the coursework & internship hours, sat for & passed the RD exam, & all of a sudden...

You’re actually a dietitian!!

(If you’re still not sure exactly what a dietitian is, find out here, and if you want to know how to become a dietitian, read this article).

Now what??

That’s pretty much how I felt after I passed the RD exam on July 29^th, 2014.

The process of becoming a dietitian (especially if you are also working) is an all-consuming one.

At times, it feels like you’re just trying to make it through the hour, the day, the week, the month. Project after project, deadline after deadline, it’s easy to lose sight of the big picture.

What exactly are you going to DO once you’re a dietitian?

You basically have 2 options:

1. Become an employee
2. Start your own business

I knew from a very young age that I was meant to be self-employed. I just have that entrepreneurial spirit! From selling “polished rocks” (rocks that I painted with nailpolish…. HAHA) and lemonade from a stand in front of my house, to selling stenciled t-shirts in high school, to hawking my services as a tutor in college, I’ve always been a hustler.

So on July 29^th, 2014, the day that I passed the RD exam, I was ready to jump head first into the world of entrepreneurship & learn as I went.

As scary as that decision was, and as many times as I fell flat on my face during my first year in business, it was hands-down the best decision I made.

You can plan, and plot, and learn, and prepare for AGES, but it won’t get you anywhere without action to go with it. The sooner you start, the sooner you’ll get to where you want to be!

If you have even an ounce of desire to go into business for yourself, you should probably give it a go.

So here’s what I did in my 1^st month as an RD entrepreneur:

First, I had to figure out when I could legally start practicing as a dietitian.

The results of the RD exam are instantaneous. You know whether you passed the minute you step out of the testing room. However, it was a little unclear whether I could legally start practicing as an RD right that second, or whether I had to wait for my ID card & for my status to officially change from “student” to “dietitian” within the AND database.

So, I called up CDR and they let me know I could legally practice right away. Yahoo!

On August 1^st, I received an email from CDR with instructions for paying the $60 registration fee. You have to pay this fee annually to maintain your status as a registered dietitian (if you don’t pay the fee within 240 days of the annual deadline, you lose your registration & have to take the exam all over again! Eek!).

Once you pay the fee, CDR sends you an ID card in the mail that proves you’re legally a dietitian, and sends you information on how to set up your Professional Development Portfolio to keep track of your 5-year cycle of continuing education credits.

(There’s no rush to set up the PDP, but you have to set up your online learning plan before you can start logging your continuing education hours).

CDR also sends you a free wall certificate to hang in your office for your 1^st year as an RD. But you have to pay to receive a new one for the following years.

Now that I had my certification, I decided to jump right into what I thought would be my best chance of entrepreneurial success: private practice.

Turns out this might not have been the best choice, but more on that later.

I had 5 main options for running my private practice:

• Rent my own private office space
• Rent a private office within a wellness center
• Sublet an office from another practitioner to use when they weren’t using it (usually a few days a week, nights, or weekends)
• Use a rent-by-the-hour office to book clients whenever they came up
• Not rent an office & meet clients at coffee shops, their houses, via Skype, or on the phone

I decided to rent a small office within an established wellness center in west Los Angeles.  

I found the space on Craigslist & signed the lease before I even passed the RD exam! I started decorating in late July so that I would be ready to open as soon as I was an RD.

I chose this space because even though it was very small (like 8 ft x 10 ft) & windowless 😉 it was very affordable (only $750/mo for your own private office, whereas other places were charging $250/mo for just ONE DAY a week in an office space!).

I also liked that it was located inside a wellness center so I could connect with other wellness professionals & perhaps share clients with them.

Plus, I loved that I could decorate to my personal tastes & book clients at any time without having to work around other practitioner’s schedules.

However, if I had to do it again, I probably would have gone with the rent-by-the-hour offices. Yes, they’re slightly less convenient, & you can’t decorate them, have an official business address, or store paperwork there, but they save you SO MUCH MONEY.

Joyce Guenther is a popular option in West LA, and she charges just $15/hour for use of her offices! This is a great deal if you only have a few clients per week.

Next up, revamping my website.

I had already been sporadically blogging over the past few years on my website, eathealthyfeelgood.com, so I decided to run with that name & launch my counseling services under the same name & website.

I was only getting ~2,000 visitors per month on eathealthyfeelgood.com, but I figured that was better than starting from 0! (I later chose to scrap this business name and website, but, my goal of this post is to be honest about where I started!)

I updated my site to include new information on my counseling services (including prices!), and added Acuity Scheduling for clients to book & pay for appointments directly on my website.

Acuity costs $10/mo, but makes scheduling SO easy. It displays a calendar of your availability, and allows clients to book sessions (individual or packages) directly from your website. It also sends confirmations & reminders if you set it up that way. I love how it syncs to your google & ical too. Fabulous & well worth the money.

If you don't have a website yet, I highly recommend purchasing a domain & getting started. I recommend Google Domains for registering your domain name and SiteGround for hosting.

Domain names (the name of your website url, like www.ericajulson.com) are pretty cheap, only a few bucks per year. Hosting (having actual space on the web to run your website) is a little more expensive, roughly $60 - $200/year, paid upfront or monthly.

Once you have a domain name & hosting, I highly recommend installing WordPress to manage your website. It gives you full control & ownership of your site, no matter what happens. There are a bazillion wordpress themes that you can download & install to make your website beautiful.

I recommend anything that uses the Genesis Framework if you want to incorporate a blog into your brand. Otherwise, a drag-and-drop visual builder, like Divi, is a great option!

Let’s talk about prices for a sec.

There are two camps in this world- those who post their prices on their website, and those who don’t.

Those who don’t post their prices argue that truly interested & motivated customers will take the extra step to contact you for a consultation. These owners like having the chance to “sell” their services before revealing prices to their customers.

The other camp of people like to just be upfront & honest about how much they charge. I find this helpful because it saves both the business owner & customers so much time. There’s no sense in selling someone on a product or service they can’t afford. I prefer to post my prices upfront, so my customers can save or budget to include my services in their lives.

How much to charge??

 I googled a whole bunch of dietitians in my area to see how much others were charging. I found a wide range of charges, from $60/hour on the low-end, to $250+/hr on the high end. I decided to settle in the mid-range ($150/hr) because I have a masters degree & I know that I go above & beyond for my clients & personalize all of their sessions. $150/hr felt like a comfortable price point for me, and pretty average for my area. Plus, I think it’s better to start where you’d like to be than start low & keep having to raise prices on people.

There’s also something to be said for the perception of value. People tend to value what they pay for, and if they’re paying decent $$$ for your services, they may be more likely to respect your time.

Here's a biggie: Should you take insurance??

This was a tough decision for me. On the one hand, being a registered dietitian allows me to take insurance, whereas other unregulated nutrition professionals (health coaches, nutrition coaches, nutritionists) cannot.

Taking insurance opens you up to a HUGE pool of potential clients whose visits would be covered by their insurance.

However, taking insurance is a lot of work! You have to contract with each insurance company, and deal with co-pays, deductibles, etc. Sometimes claims can get denied, and then it is a huge headache and hassle.

Also, anyone who takes insurance has to follow HIPAA privacy guidelines (that means no Skype appointments!), which I didn’t really want to worry about when I was just getting established & had so much on my plate. This is up to interpretation, but some believe that the strict HIPAA guidelines don’t apply to private-pay dietitians since you are not a "covered entity", according to the HHS definition.

I decided to start out with private-pay only, so I wouldn’t have to deal with the hassle of insurance & HIPAA requirements. This way, I could receive payment immediately when I saw my clients, do Skype appointments if I pleased, and not have to worry about HIPAA requirements like putting a privacy disclaimer in the footer of all my emails. (*Please note I am not a lawyer, and not everyone agrees with this! Some believe that HIPAA applies to all dietitians, whether private pay or not. I recommend consulting with a lawyer in your state for more clarification).

For the legal stuff…

I had to decide whether I wanted to run my business as a sole proprietor, LLC, or corporation.

Ideally, I would have loved to be an LLC (limited liability corporation), because it protects your personal assets if you go bankrupt or are sued. However, it actually costs money to establish an LLC (In California, it's a $20 reporting fee + $149 for Legal Zoom to file for you + $800 annual LLC tax due 75 days after filing).

I decided to save $1,000 and take my chances as a sole proprietor since I wasn’t sure how much business I would actually do during my first year, and didn’t really have any assets to protect (I definitely had a negative net worth at this point).

*Side note* Legal requirements vary by state. Everything mentioned in this article is specific to the requirements for California. Check with your state for more specific information. 🙂

Once I decided my business structure, I did the following:

1. Registered my business with the City of Los Angeles Office of Finance.

You have to register your business no matter what, but if you make less than $100,000 in Los Angeles, you get a small business exemption & don’t have to pay business taxes.

2. Filed my DBA paperwork at the local courthouse.

This allowed me to legally do business as “Eat Healthy Feel Good” instead of just Erica Julson. This way, clients can make checks out to Eat Healthy Feel Good or Erica Julson, and both will go through at my bank.

*Note * you have to renew your DBA every 5 years, or else you lose your business name.

3. Published a DBA announcement in the newspaper.

This was the strangest requirement to me! You have to legally publish a statement saying “[Your Name] is doing business as [Your Business Name]”. That way the public can find out the name of the person behind any business.

I published mine in the British Weekly for $30 (via 30dollarDBA.com). The whole process was pretty easy. It just required payment & faxing some paperwork. The company mails you a copy of the paper your notice is published in :).

4. Applied for a Tax EIN (Employer Identification Number).

You don’t HAVE to do this, but it’s a wise choice. Having an EIN allows you to avoid putting your personal social security number on forms, so it helps protect your identity.

5. If you also want to sell stuff, you need a seller’s permit.

If you want to sell goods at your office (vitamins, supplements, t-shirts, etc.), you’ll need a seller’s permit to legally do this. I decided not to jump into this right away, but it’s something to be aware of!

Next, I set up my financials.

1. Opened a business banking account.

 I walked into my current bank with my DBA documentation & tax EIN in hand & set up my business banking/checking account!

Having a separate business account makes it easy to keep your financials straight. You can take payments directly into your business account & make business purchases on a separate business debit/credit card. They also provide you with business checks so you can look super official when paying for stuff!

2. Signed up for Square.

This is my preferred method for taking payments. I love how you can swipe people’s credit cards wherever you are for just a 2.75% processing fee, or have your clients submit credit card processing forms and hand-enter their card information for recurring payments (helpful if they are on a monthly payment plan).

Funds are deposited into your bank account the next business day, in comparison to PayPal which takes like 5 days to go through. This is HUGE when you’re just starting out and need quick cash.

3. Created an accounting spreadsheet

I know a lot of people like to use Quickbooks for their accounting, but I like keeping it old school!

I created an excel spreadsheet with 1 tab for each month. In each tab, I tracked my income, expenses, and gross/net profits for the month & the year to date.

As a small business owner, it is ESSENTIAL that you know where your finances are. It's a great idea to track your income & expenses weekly, so you always know where you're at, & how far you have to go to reach your goals. Being organized also helps a ton come tax time.

There were also a lot of professional-related things I needed to do...

1. Renew my professional liability insurance

I chose to renew through Proliability to protect myself from malpractice lawsuits. I already had malpractice insurance through them while I was an intern, so I decided to just use them again. They offered a slight discount for new RDs, so that was helpful. The cost was only $60 for the whole year.

2. Purchase general liability insurance.

This is a separate insurance that covers slip & fall accidents in my office space. I was required to add the owners of the wellness center as co-insured on my policy as well (a common requirement), which increased the cost a little bit. I ended up purchasing a policy through Hiscox because they were able to find me the best deal. It cost $60 for the 1st month, and then roughly $40/month for the rest of the year.

3. Obtain an NPI number from the Centers for Medicare & Medicaid Services.

You need an NPI number if you want to take insurance or if you DON’T want to take insurance, but want to be able to create superbills for your clients to submit to their own insurance for reimbursement.

I also had to decorate & furnish my office!

This was the fun part 🙂 I went on a World Market shopping spree & decked out the space at a very reasonable price.

I opted to set up my office with 2 comfy plush chairs rather than a formal desk option. I felt that sitting side by side with my clients would make them feel more comfortable & able to open up to me, compared to sitting behind a desk, with my client sitting before me as if I am the ultimate authority on nutrition. I got really good feedback from my clients on the vibe of my office, so I think it was a good choice!

Once I had my office ready to go, it was time to create my business paperwork!

For many people, this is a tough task to tackle. But luckily, creating forms & procedures & structure is a strength of mine, so I enjoyed the process!

Here’s a handy checklist of the templates I created:

• Welcome email that people received after booking their 1^st appointment.
• A 9-page “Initial Appointment Welcome Letter & Health Information Form” for clients to fill out & return to me before our 1^st session. This helped me prepare & be on the same page as my client when we first met.
• A “New Client Agreement Form” to help protect myself against litigation.
• A “What to Expect at Your 1^st Appointment” letter to help clients understand exactly what our first session would be like.
• Recurring Payment Authorization form so that I could store people’s credit cards on file & charge monthly for packages.
• Superbill template for clients to submit to their insurance companies for reimbursement.
• Client session templates for me to take notes on during our sessions.
• Newsletter sign-up sheets to use at events.
• Gift certificate templates.

To organize my client forms, I did the following:

• Created 1 manila folder for each client.
• Stored client folders alphabetically in a locked filing cabinet.
• I stored the health information form, health agreement form, session notes, & any handouts I gave them in their folder.
• I took this folder to each session for easy reference, in case there was any confusion about what we talked about in the past or what handouts were provided when.
• If I was seeing a client for a long period of time, I split their materials into several folders, but kept it organized chronologically.

I chose to take notes by hand during our sessions because it’s just the way my brain works best. I like to jot down notes, draw arrows to connect things, cross things out as I cover them. Plus it felt a little impersonal to have my computer or tablet in front of me during our sessions. I wanted my full attention on my client.

Since I didn’t have a lot of clients, and wasn’t coordinating or sending notes to physicians, the old-school pen & paper method worked well for me. I know other people who absolutely love their electronic charting methods though, especially Practice Better!

Next up, creating marketing materials!

I was basically starting from square one in terms of marketing, & I was on a super low budget! I’ll outline my marketing methods in more detail in my next post, but I’ll give you a quick preview of what materials I created when I first started out.

• Rack cards (with my picture, logo, story/philosophy, business info, & coupon). My uncle owns a printing company (Fineline Printing), so I was able to get these done for free! (Thanks, Uncle Richard!!)
• Business cards from moo.com (my fave!)
• A business facebook page (I technically already had this, but it’s a marketing essential if you don’t already have one)
• A business Twitter handle (technically already had)
• A business Instagram account
• An updated LinkedIn page
• A Yelp page
• A Google+ business page
• If you don't already have a logo, you can design your own on canva.com, pay someone to design for you on fiver.com, or have people compete to create your logo at 99designs.com.

Don't skimp on any of these! I got new clients from both Yelp & Google+, so make sure you're highly visible & easy to find on the internet.

And finally, creating handouts!

Even though I didn’t have any clients yet, I wanted to have at least a few handouts to provide as a standard part of my 1^st session.

I created a handout with my general nutrition/wellness philosophy, and some questionnaires I thought I might want to use, centered around emotional eating, self-care, & general wellness.

I figured I would make the rest as I went on, based on client need.

A few resources that really saved my butt during this time:

 To help guide me through this process, I purchased Making Nutrition Your Business by the amazing dietitians Faye Berger Mitchell & Ann M. Silver. This book was a godsend for helping me figure out the steps I needed to take to set up my office & business. Without this book, I would have struggled to understand the pros & cons of taking insurance vs private pay, the paperwork I needed to file, and how to go about marketing myself.

I also joined the Nutrition Entrepreneur dietetic practice group (NEDPG) & the Dietitians in Integrative & Functional Medicine practice group (DIFM), which were HUGE invaluable resources. I was able to search their listserv archives to answer almost any question I might have about starting a private practice & treating clients.

I also read a bunch of nutrition books!

There is A LOT of self-education that goes on when you first start your practice. Here are some books that I relied on heavily while crafting my counseling style:

And NOW, if I had to do it over again, I would strongly consider investing in more 1:1 guidance. 

Working with a coach or taking a course that was specific to starting a private practice would have gone a LONG way in speeding up my success.

There is a lot of trial and error involved in business, so working with someone who has been-there-done-that can save you from these missteps.

My favorite course is Jennifer McGurk's Pursuing Private Practice (this is my affiliate link for her course). 

Jennifer is a powerhouse RD with years of experience coaching other dietitians on launching and growing private practices. She also does 1:1 mentorship and clinical supervision for eating disorder RDs and is an all-around excellent resource.

Total costs to open:

• $750 security deposit
• $750 first month’s rent
• $25 business cards from moo.com
• $10 for acuity scheduling software for my website
• $200 for office supplies (clipboards, pens, folders, filing system, tissues, candles, notebooks, thank you cards, etc.)
• $26 to file my “Doing Business As” paperwork
• $30 to publish my DBA announcement in the newspaper
• $58 for general liability insurance
• $59 for professional liability insurance
• $125 for a scale & blood pressure monitor (which I never used lol)
• $2000 for office furnishings (chairs, rug, tables, décor)
• $100 if you don’t already have a website (this covers the cost of your domain name, hosting fees, and wordpress theme)
• $100 on miscellaneous books to help me learn counseling styles/theories

= $4,233

And yep, that all went on a credit card. Eek!

Check out the next post for the lessons I learned during my 1^st year in business. I share the details on exactly what my expenses were, & how much I earned over the course of my first year. You'll learn a ton, promise!

 

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