Med spa medical director agreement checklist: what to settle before you sign
A med spa medical director agreement should say, in numbers and names, how the physician will meet the supervision duties your state imposes: which procedures are covered, who examines patients, how fast the director answers the phone, how many charts get reviewed each month and what happens after a complication. This checklist lists the points to settle and the clauses to raise with your healthcare attorney. It is not a contract template and not legal advice.
- Use this as an agenda for your attorney, not as contract language.
- Write numbers into the agreement: response times, on-site hours, charts reviewed per month.
- List every procedure, drug and device covered and which roles may perform each one.
- Pay a fixed fee at fair market value for documented duties; revenue-share pay needs careful legal review.
- Plan the exit: notice, records custody and cover until a new director starts.
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How to use this checklist
Short answer: agree the business terms below with your medical director, write down the answers, then hand them to a healthcare attorney licensed in your state. The attorney turns them into contract language that fits your state’s delegation, ownership and fee rules.
Two facts shape every agreement. First, the legal duties come from your state, not from the contract. In Texas, for example, the delegating physician must make sure staff are trained and have signed written protocols, and a physician, PA or APRN must be on site or immediately available (22 Tex. Admin. Code §169.26). A contract cannot reduce those duties; it can only show how they will be met. Second, the structure has to be lawful before the contract matters. In states with corporate practice of medicine rules, a lay-owned business may not provide medical services at all, so check our med spa ownership rules by state first.
Read the medical director requirements pillar for the duties and a 15-state rule table.
1. Parties, licenses and scope of services
- Who contracts with the physician: the professional entity, a management company, or both. The answer depends on your ownership model.
- The physician’s license number, state, specialty and any board certification, with a duty to tell you within a set number of days about any board action, investigation, malpractice claim or loss of DEA registration.
- A schedule listing every procedure covered: neuromodulators, fillers, biostimulators, laser and IPL by device, radiofrequency microneedling, chemical peels by depth, IV therapy, weight-loss medications, hormone therapy.
- For each procedure: which roles may perform it (MD/DO, PA, NP, RN, LPN, laser technician or esthetician where your state allows) and any extra training required.
- Procedures that are excluded, so nobody assumes coverage. New procedures added only by written amendment after training is documented.
- Every location covered, and whether the physician must visit each one.
2. Availability, on-site time and back-up cover
- The supervision standard your state uses, written into the contract in plain words: on site, immediately available, readily available, or reachable within a stated time.
- Scheduled on-site hours per week or month for each location, and how attendance is recorded.
- Maximum phone response time while treatments are running. Washington, for example, requires the physician to be reachable and able to respond within 30 minutes for FDA-approved injectables (WAC 246-919-606).
- Named back-up physicians for vacations and illness, with their own signed agreement and protocols. Washington’s laser rule requires a local back-up physician who agrees in writing to treat complications and can see the patient within 60 minutes (WAC 246-919-605).
- What happens if no supervisor is reachable: delegated procedures stop until one is.
- How the physician learns the treatment schedule in advance, so supervision is planned rather than assumed.
3. Good faith exams, orders and protocols
- Who performs good faith exams (physician, PA or NP), whether telehealth exams are allowed for each procedure in your state, and how they are documented. See the GFE guide and the telehealth GFE rules by state.
- When a new exam is required: new patient, new treatment area, new product, change in health history, or after a set time.
- Form of orders: patient-specific orders for RN injectors (New York requires these), and whether any standing orders are used at all.
- Written protocols for each procedure, with patient selection, contraindications, settings or dose ranges and complication steps. Texas requires the written order to identify the delegating physician and include screening criteria, appropriate care and procedures for complications and emergencies (§169.27).
- Annual protocol review date and who signs.
- Drug purchasing, storage, temperature logs, lot tracking and disposal: who is responsible, and under whose license drugs are ordered.
4. Training sign-off and chart review cadence
- Competency sign-off for each clinician and procedure before independent work, kept on file. Colorado requires the physician to personally assess each delegate, including direct observation (3 CCR 713-1, Rule 1.17).
- Chart review: the number or percentage of charts reviewed each month, how they are picked, and a requirement to review every chart with a complication, unusual dose or patient complaint.
- Meetings: frequency and documentation. Texas requires prescriptive authority meetings at least once a month (Occupations Code §157.0512).
- Limits on the number of clinicians supervised, at least matching state caps. Texas caps prescriptive authority agreements at seven PAs/APRNs or the full-time equivalent (§157.0542).
- Credential re-verification at each license renewal, and who tracks expiry dates.
5. Adverse-event response
- A written first-hour plan for the complications that matter in aesthetics, such as vascular occlusion after filler, anaphylaxis, burns and IV reactions, with the supplies kept on site (for example, hyaluronidase where fillers are used, and an emergency kit).
- Who calls the physician, how fast, and when to call 911.
- Staffing: Texas requires at least one person trained in basic life support present while the patient is on site (§169.26).
- Follow-up: who sees the patient, when, and how it is documented.
- Incident review within a set number of days, with protocol changes signed by the physician.
- Reporting duties, including notice to insurers and any state reporting requirement.
6. Compensation that avoids fee-splitting
Short answer: pay for documented time and duties, at a rate you can show is fair market value, and do not tie the physician’s pay to referrals or revenue without a specific legal opinion.
- A fixed monthly fee, an hourly rate for documented time, or both, with a written basis for the amount.
- Time logs or activity reports showing exams, chart reviews, meetings and on-site hours.
- No payments per patient referred and no percentage of revenue unless counsel has confirmed it is lawful in your state. Florida, for example, lists “any split-fee arrangement” among grounds for physician discipline (Statutes §458.331(1)(i)).
- If any patient is covered by Medicare, Medicaid or another federal program, a review under federal anti-kickback and self-referral rules.
- If the physician also owns part of the business, a separate review of ownership, distributions and management fees.
7. Insurance, indemnity, records and privacy
- Professional liability coverage for the physician that covers supervision of others and every listed procedure, with limits stated and certificates exchanged each year.
- Entity coverage for the business and confirmation that each clinician is insured.
- Tail coverage on claims-made policies when the agreement ends, and who pays for it.
- Mutual indemnity terms (they move money, they do not protect a license).
- Who is the custodian of medical records, where they are kept, and how long. State law sets chart retention periods; HIPAA separately requires covered entities to keep required compliance documentation for six years.
- HIPAA roles: privacy and security officers, and a business associate agreement with any vendor that handles patient information, including your marketing agency. See HIPAA compliance by role.
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8. Marketing approval, term and termination
- Physician review of treatment, result, safety and credential claims before they run on the website, Google Business Profile, social media or ads.
- How the physician’s name and photo may be used, and removal when the agreement ends.
- Postings required by your state. Texas requires the delegating physicians’ names and license numbers in public areas and treatment rooms, and name tags showing each person’s credentials (§169.28).
- Term, renewal and notice periods long enough to recruit a replacement.
- Immediate termination events: loss or restriction of license, exclusion from federal programs, loss of insurance, unlawful instructions.
- Transition: delegated procedures stop if no qualified supervisor is in place; protocols and postings updated when a new director starts; patient follow-up continues.
Marketing claims also have to follow the state board’s advertising rules. Start with the guide for your state, such as Texas, California or Florida, and see the med spa marketing statistics for 2026 and our med spa Google presence report for benchmarks. More guides are in the US guides library, or you can book a call with the US team.
Not legal advice. This checklist is a planning aid for business owners. It is not a contract, a template or a legal opinion. Delegation, ownership and fee-splitting rules vary by state and change often; have a healthcare attorney licensed in your state draft or review your agreement.
Sources
- Texas: 22 Tex. Admin. Code §169.26, §169.27, §169.28 · Occupations Code chapter 157
- Washington: WAC 246-919-605 · WAC 246-919-606
- Colorado: 3 CCR 713-1, Rule 1.17
- New York: NYSED, non-patient specific orders and protocols
- Florida: Statutes §458.331
- HIPAA documentation retention: 45 CFR 164.316(b)(2)
- Federal: HHS-OIG, fraud and abuse laws
Related pages from the US team
Medical director requirements
Duties, supervision models and a 15-state table.
Good faith exam (GFE) guide
Who may perform it and how to document it.
Telehealth GFE rules by state
Where a GFE can be done by video.
Med spa ownership rules by state
Who may own a med spa and the management company model.
HIPAA compliance by role
Privacy duties for owners, directors and staff.
Med spa marketing agency USA
How Ichelon Consulting US works with med spas.
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Common questions
Is there a standard med spa medical director agreement?
No. Templates circulate, but supervision, delegation, ownership and fee rules differ by state, so a template written for one state can create violations in another. Use a checklist like this to agree the business terms, then have a healthcare attorney in your state draft or review the contract.
How often should a medical director review charts?
Follow any state requirement first. Texas, for example, requires chart review and monthly meetings under prescriptive authority agreements with PAs and APRNs. Where there is no set number, many agreements review every chart for a new clinician's first weeks, then a fixed monthly sample plus every chart with a complication.
Can the medical director be paid a percentage of revenue?
It is risky. Florida lists split-fee arrangements as grounds for physician discipline, other states have similar fee-splitting rules, and federal anti-kickback law applies if federal healthcare program business is involved. A fixed fee at fair market value for documented time and duties is easier to defend. Ask counsel before using any variable pay.
What should happen when a medical director leaves?
The agreement should set a notice period long enough to recruit a replacement, say who keeps patient records and for how long, require updated protocols and posted information when the new director starts, and stop delegated procedures if no qualified supervisor is in place.
Should the medical director approve marketing?
Yes for anything that makes a treatment, result, safety or credential claim. State boards hold licensees responsible for advertising, and claims such as physician-led or board-certified injectors must match who actually treats patients.
A note on this guide: it explains marketing practice, not legal advice. Rules on privacy, advertising and insurance change and vary by state, so confirm anything compliance-related with your own counsel.
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