Opening an Acupuncture Practice: What to Ask Your Realtor About a Potential Space

Opening an Acupuncture Practice: What to Ask Your Realtor About a Potential Space

Hook: You’ve trained for years, built a referral base, and now the biggest barrier is finding a space that’s safe, legal, and clinic-ready—without losing money or time to rework. The wrong lease or a misinformed realtor can cost you months of permits and thousands in build-outs. This guide gives you the exact questions and red flags to bring to any realtor—especially when large brokerages and urban market shifts are changing what “clinic-ready” means in 2026.

Why this matters right now (2026 market context)

In late 2025 and into 2026, two trends accelerated: major commercial brokerages expanded their urban healthcare and wellness portfolios, and cities increased municipal incentives for office-to-medical conversions. That means more available inventory—but also more complexity. Large brokerages may list flexible spaces that sound perfect for a practitioner but are governed by corporate leasing playbooks that favor high-rent uses and restrictive clauses.

Meanwhile, tenant expectations have shifted: patients now rate practices on clean air, privacy, and digital booking. Municipal codes are updating to address clinical HVAC, sharps disposal, and mixed-use residential conversions. You need specific, practical questions to separate a promising site from a costly mistake.

How to use this article

Start with the pre-viewing checklist so you know what to ask a realtor on the first call. Use the on-site checklist during walkthroughs. Follow the due-diligence checklist before you sign a Letter of Intent (LOI) or lease. Finally, review the red flags section to avoid traps common with large brokerages and new office-to-medical listings.

Pre-viewing questions to ask your realtor (first call)

• Is the space currently zoned for medical/healthcare use? Ask for the exact zoning code and allowable uses—some “office” zones prohibit in-person medical treatment.
• Does the listing come from a corporate brokerage or an independent landlord? Corporate brokerages often have standardized lease forms, accelerated timelines, and limited TI (tenant improvement) flexibility.
• What is the Certificate of Occupancy (C of O) classification? Request a copy or summary. A C of O for office does not always allow clinical use without change of use.
• Are there other healthcare tenants in the building? Co-location with physicians, dentists, or mental-health providers suggests medical-friendly infrastructure.
• What is the current asking rent structure? NNN, gross, or full-service? Ask for CAM (Common Area Maintenance) history and typical escalations.
• Is subleasing or assignment allowed? Important for future flexibility if you scale or sell your practice.
• Are there existing service contracts the tenant must use (HVAC, pest control, janitorial)? These can add operating costs and limit vendor choice.
• How long is the approval process for TI and build-out with the landlord? Large brokerages often require vendor pre-approval that extends timelines.

On-site walkthrough checklist (what to inspect and ask in person)

• Layout suitability: Look for adequate private treatment rooms (or space to create them), a reception area, storage for needles & supplies, and an accessible restroom for patients.
• Plumbing & electrical: Does the unit have a sink in or near the treatment area? Can you install a sterilization sink? Check amperage and dedicated circuits for equipment like E-stim or electroacupuncture machines.
• HVAC & ventilation: Ask for recent HVAC maintenance records. For clinical spaces, good ventilation and independent controls reduce infection risk and improve patient comfort.
• Sound privacy: Are walls and doors adequate for patient confidentiality? Thin partitions can mean additional build-out costs for soundproofing.
• Natural light vs patient privacy: Windows are welcome, but you may need frosted film or blinds for modesty—confirm landlord rules.
• Access & egress: Check stair and elevator access for patients with mobility issues. Confirm emergency exits and evacuation routes.
• Parking & transit: How many dedicated spots? Is street or garage parking reliable? Proximity to transit improves patient access—especially in urban markets.
• Signage & street visibility: Can you place external signage? Many brokerages limit signage to preserve facade uniformity.

Due-diligence checklist before signing an LOI or lease

Before you commit any deposit, gather these documents and answers. If the realtor hesitates or won’t provide them, treat that as a red flag.

1. Provide/Request official documentation:
   • Current lease or rent roll
   • Certificate of Occupancy and any change-of-use approvals
   • Floor plan and measured drawings
   • Building rules & regulations and any medical-specific addenda
   • Insurance requirements and required certificates
2. Confirm zoning and licenses: Contact the local planning department or verify with the realtor that the space allows acupuncture and in-person clinical services.
3. Confirm sharps/biohazard procedures: Ask if the building has policies or licensed vendors for medical waste removal. If not, confirm you can contract externally.
4. Verify ADA compliance: Confirm restroom accessibility, door widths, and patient flow. Note any required upgrades and who pays for them.
5. Ask for utility histories: Electricity, gas, and water costs help forecast operating expenses—vital if rent is NNN.
6. Fire and safety code compliance: Request inspection certificates, sprinkler systems, and fire alarm info. Clinical use can change occupancy load calculations.
7. Confirm HVAC/service agreements & air quality data: Large brokerages sometimes centralize HVAC budgets—clarify whether tenant control is allowed for clinic hours.
8. Clarify TI allowances & timelines: Ask for an itemized TI allowance and an approval process timeline for contractors and drawings. Request a clause for reimbursement or turnover if delays occur.

Lease terms and negotiation points specific to acupuncture practices

Commercial leases are negotiable. Even with large brokerages, small medical tenants can secure favorable terms if they ask. Focus negotiation on these points:

• Permitted use clause: Add “acupuncture” and “integrative health services” explicitly to permitted uses to avoid future disputes.
• TI (Tenant Improvements): Secure a written allowance and a cap on landlord-approved vendor markup. Define milestones and payment schedules.
• Exclusive rights: If you’re concerned about another acupuncturist or competing wellness clinic in the same building, negotiate an exclusivity clause.
• Early termination & sublease options: Add flexibility for assignment/subletting to protect against relocation or growth constraints.
• Rent-free or reduced-rent fit-out period: Negotiate a rent abatement period during build-out and permit wait times.
• Operating expense caps: For NNN leases, seek caps on CAM increases or a year-over-year limitation.
• Signage and marketing permissions: Confirm rights for exterior and lobby signage as well as digital listings in the building directory.
• Indemnity and insurance: Limit broad indemnity clauses. Confirm required professional liability, general liability, and medical malpractice coverages.

Red flags to watch for (and what to do if you find them)

Some issues are deal-breakers; others are negotiable. Below are clear red flags and recommended responses.

• No Certificate of Occupancy or C of O mismatched to clinical use: If the landlord can’t produce a matching C of O, pause. You may face a lengthy change-of-use process and fines. Require the landlord to handle change-of-use as a condition of lease.
• Prohibited medical uses in lease language: If the draft lease expressly forbids clinical treatment, it’s a non-starter unless changed in writing.
• Unclear or extremely limited TI allowance: A minimal TI with impossible approvals means you’ll fund expensive build-outs. Negotiate fixed allowances or choose another space.
• Shared HVAC without zone control: If you can’t control ventilation during clinic hours, patient comfort and infection control suffer. Insist on HVAC controls or in-unit filtration responsibilities clarified.
• Brokerage delays or vendor lock-in: Corporate brokerages sometimes require pre-approved contractors that add cost and time. Push for landlord approval of your licensed contractor or a reasonable alternative.
• Unreasonable signage or marketing restrictions: If patients can’t find you, you’ll lose business—negotiate clear signage rights.
• Excessive CAM or undisclosed assessments: Ask for historic CAM statements. Unexplained spikes are a financial risk.

Practical steps and timeline for moving from search to opening

1. Weeks 1–2: Market scan & pre-screen
   • Use targeted realtor questions to narrow options. Filter listings by C of O, existing medical tenants, and TI allowances. Use PropTech site-selection tools and market reports where available.
2. Weeks 3–4: Site visits & LOI
   • Bring the on-site checklist. If a space passes, submit an LOI with key contingencies (zoning confirmation, TI allowance, landlord-paid change-of-use).
3. Weeks 4–12: Due diligence & permit applications
   • Hire an architect or clinic-experienced contractor to produce plans. Confirm HVAC, plumbing, and fire code needs. Submit permit applications early—municipal reviews are taking longer in 2026 due to updated clinical codes.
4. Weeks 12–20: Build-out & equipment installation
   • Schedule contractor work, order furnishings, and set up EHR/booking systems. Coordinate with the landlord on inspections and punchlist items.
5. Week 20+: Opening & continuous compliance
   • Complete final inspections, set up clinical waste contracts, and begin patient scheduling. Keep copies of all approvals visible and accessible for inspections.

2026-specific considerations and advanced strategies

In 2026, several new dynamics matter for acupuncturists choosing space:

• Brokerage expansion into wellness verticals: Large firms list more flex and hybrid wellness suites—use this to your advantage by comparing multiple listings within a brokerage to negotiate concessions.
• Municipal incentives for office-to-medical conversion: Many cities launched grants and fast-track permits in 2025 to repurpose underused offices. Ask your realtor if the property qualifies for local incentives or tax abatements.
• Indoor air quality (IAQ) & ESG standards: Patients now expect HEPA, MERV-rated filtration, and visible IAQ certifications. Negotiate landlord commitments on filtration or allowance for supplemental units.
• PropTech site-selection tools: Use real-estate analytics and heatmaps to evaluate patient access, foot traffic, and nearby referral sources. Ask your realtor for market reports and demographic analyses—don’t rely solely on the listing description.
• Hybrid models and shared clinic spaces: Wellness co-ops and clinic-shares expanded in urban markets in 2025. If you want lower start-up costs, explore established shared clinics—but verify exclusivity and sterilization protocols.

Case study (example from practice opening in 2025)

Jane, an L.Ac. in a major U.S. city, worked with a national brokerage listing in late 2025. The space had strong foot traffic but an office-only C of O. By insisting the landlord secure a change-of-use and agreeing to a 6-month rent abatement during permits, Jane avoided a six-figure renovation and opened on schedule. Her key wins came from asking for explicit clauses about TI timelines and tenant control of HVAC during clinic hours.

"Ask for what you need in writing. Silence is the biggest cost in practice real estate." — Senior clinic tenant advisor

Checklist: Questions to ask your realtor (copyable list)

• What is the exact zoning code and permitted uses?
• Can you provide the Certificate of Occupancy?
• Are there current medical tenants or similar uses in the building?
• What is the rent structure (NNN/gross) and current CAM history?
• What TI allowance is offered and what’s the approval process?
• Are there restrictions on signage or exterior wayfinding?
• Is HVAC zoned and controllable by the tenant?
• Are service contracts vendor-locked or flexible?
• What insurance certificates are required and who pays for building-level policies?
• Is subleasing or assignment allowed? Any exclusivity clauses?
• Who handles waste removal for sharps/biohazard?
• How long are landlord approval timelines for permits and build-outs?

Final takeaways

Finding the right acupuncture practice space in 2026 means more than square footage and rent. It’s about permitted use, clinical infrastructure, clear build-out timelines, and lease terms that protect your future. Large brokerages offer more inventory—but also standardized processes that require precise questions and written contingencies.

Use the checklists above on every call and walkthrough. If anything is unclear, ask for it in writing. Invite an architect or contractor experienced in medical builds early, and consider municipal incentives that can reduce costs. With the right questions, you’ll turn a promising listing into a reliable, compliant clinic that lets you focus on patient care.

Next steps — ready to vet a space?

If you’re actively searching, download this checklist, bring it to your next realtor meeting, and save time on costly surprises. If you want tailored help, book a short consultation with a clinic real-estate advisor who understands acupuncture-specific needs and 2026 zoning trends. Your practice location should support healing—not headaches.

Call to action: Request the printable realtor checklist or schedule a 30-minute consultation to review a lease or LOI. Make your next space your last costly relocation.

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