How to Open a Nurse-Owned Practice in California

You've done the math in your head more than once. A few injectable appointments on your day off, on your own schedule, in your own space, and suddenly the shifts you pick up out of obligation start to look optional. California is the biggest aesthetics market in the country by a wide margin, and outside of L.A. and the Bay there are still whole counties where the nearest injector is a 40-minute drive. That gap is the opportunity. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in California was never the clinical work. You already do harder things on a Tuesday than a first tox or IV appointment will ever ask of you. What stops people is everything around it, the ownership rules, the medical director, the setup, all sitting there as one giant undefined to-do. So let's take it in order, starting with the question every California nurse asks first.

Can a nurse own an aesthetics, wellness, or functional health practice in California?

Not outright. California has the strictest corporate practice of medicine rule in the country, and the Medical Board applies it to med spas by name. Tox, filler, IV therapy, and GLP-1 protocols are the practice of medicine here, so the entity that delivers them has to be a physician or a professional medical corporation that physicians majority-own (Bus. & Prof. Code §2400; Corp. Code §13401.5). The Board's own med spa guidance goes one step further: a physician who signs on as medical director of a lay-owned business is "aiding and abetting the unlicensed practice of medicine." Nurses run practices in California every day, inside a structure built around that rule, and the structure is more involved than in a full-practice-authority state.

The California rule that catches almost everybody

The 49% cap. Under Corporations Code §13401.5, a medical corporation must be majority-owned by California-licensed physicians. Registered nurses are on the list of other licensed professionals who can hold shares, and together those holders can't own more than 49% of the stock, and there can't be more of them than there are physician shareholders. A plain LLC can't practice medicine at all. In practice, a nurse-run California practice usually has two pieces: a physician-majority professional corporation for the clinical side, and a separate management company the nurse owns for everything non-clinical, paid a fixed, fair-market fee because California's fee-splitting ban (Bus. & Prof. Code §650) forbids percentage-of-revenue deals. It's the same architecture the big chains use, and it has to be papered by a California health care attorney.

Your medical director will almost certainly be a physician here, at least for now. AB 890 created two new NP categories: a 103 NP, who practices without standardized procedures only inside a group setting where at least one physician also practices (Bus. & Prof. Code §2837.103), and a 104 NP, who can practice without standardized procedures outside a group setting (§2837.104). Getting there is slow: 4,600 hours or three full-time-equivalent years of transition-to-practice in California, then three more years as a 103 NP before applying for 104. The Board of Registered Nursing only began taking 104 NP applications in 2026. Every other NP works under standardized procedures with a physician. Whether a 104 NP can run cosmetic injectables through a nursing corporation with no physician involved is something the law firms are still arguing about, so don't build a plan on it yet.

The initial patient evaluation, which some states call a good faith exam, can't be delegated to an RN in California. The Medical Board says a physician must perform the appropriate prior examination before prescription drugs or devices are used, and an NP may do it under standardized procedures. It can be done by telehealth: Bus. & Prof. Code §2242(a) says the exam doesn't require a synchronous interaction and can be met through telehealth, including a questionnaire, as long as the standard of care is met. After that exam you inject under standardized procedures (Bus. & Prof. Code §2725; 16 Cal. Code Regs. §1474), and the physician doesn't have to be on site, though the Board expects them to be immediately reachable.

One that surprises people: LVNs can't inject tox or filler in California at all, which is not how it works in Texas. And every LLC owes the Franchise Tax Board $800 a year whether or not it made a dollar, which, yes, is as annoying as it sounds.

How Five Square actually gets you started

The whole thing lives in one place: the free Five Square Nurses app. Your medical oversight, the step-by-step training, your pharmacy and vendor accounts, and the entire community of nurse business owners are all in there. You can open it between patients, on a lunch break, or on the couch at 9pm, and pick up right where you left off.

When you join, you're not handed a login and wished good luck. There's a Getting Started path that puts the order of operations right in front of you, so the mountain becomes a checklist.

You pick your lane, or combine them. Five Square supports three:

• Aesthetics. Tox and dermal filler, the core of a nurse-injector practice, with room to add more as you train.
• Wellness. IV therapy and vitamin injections. Low startup, very mobile-friendly, and a natural add-on to aesthetics.
• Functional Health. Peptides, lab work, and whole-person care for nurses who want longer-term, relationship-based patients.

You bring the nursing license and the nerve. We bring the medical director, the compliant California setup, the training, member pricing on products, marketing help, and weekly live calls with experts and other nurse owners, so you're never stuck guessing alone.

And every Five Square member, brand new or already established, gets instant on-demand Good Faith Exams for $19.99 each, a price we subsidize because we believe in nurse success. A walk-in can be cleared in about a minute, seven days a week, and the exam paperwork lands right in the patient's chart, which is exactly what a state board wants to see.

You start before you feel ready, and that's the point

Most programs make you wait. Watch every module, sit through every call, and someday you finally see a patient. By then half the people who started have lost momentum. Five Square runs the other way: you start your practice while you're still finishing the training, because the training sticks when there's a real patient on next week's calendar.

Kayla, an ER nurse in North Carolina, had never injected anyone when she joined. She watched the videos, took notes, and set a goal of 30 people in 30 days. Here's the advice she'd give a nurse who's scared to start:

"Believe in yourself, even when you don't know how to do something. Figure it out. The clinical knowledge from your nursing career is more than enough to get started, and there's a community of people around you who want to help. Do it scared."
- Kayla, ER nurse

She launched April 4. Her first month: 46 appointments, 28 good-faith exams, and $10,320 in revenue, run out of a single room inside a salon she'd been a client at for years. That's one real month from one real nurse, not a typical result and not a promise, and your market and hours are your own. The point is she was exactly where you are, never-done-this-before, and she started anyway.

Does it actually work once you launch?

Getting launched is step one. What you really want to know is whether it works after that. Here's the honest picture, numbers included, because income claims in this industry deserve a skeptical read.

Results vary, and they depend on things no membership controls: your market, your hours, how long you've been at it, how consistently you market. As practices mature, some established members report months in the $10,000 to $20,000 range. Individual results vary widely. Some land higher, some lower, and nobody here will promise you a number.

What's more useful is the math underneath, which is public. Neurotoxin appointments bring in $200 to $600. A syringe of filler runs $500 to $800. IV sessions run $150 to $350. Functional health consults run $150 to $300, often with patients coming back monthly. At those prices, two to four appointments a month would cover the $899 membership before product costs, and everything past that is the business growing. Want to see it with your own pricing? Run your numbers in the Five Square membership earnings calculator.

The nurses say it better than a revenue range does:

"The support is unreal. I did my first lip fillers and felt completely confident thanks to the training and the team."
- Tammi B., RN

"I started with Five Square last spring and they've helped me every step of the way. Trainings, weekly meetings, check-ins. An abundance of resources to actually make you successful."
- Kendra P., 5-star Google review

Inside the community, the wins show up in real time. A nurse a few weeks into her launch posted she was already up to eight bookings, nearly all of it from one post in a local mom's Facebook group. Another saw a husband and wife for their good-faith exams in under ten minutes using the same-day exam tool when her director wasn't free. Scroll the forum any week and it's full of small wins like these.

The Google rating sits at 4.8 stars, and the reviews keep naming the same things: the setup help, the medical director, the training, and a team that answers when you're stuck.

Already run a practice in California? There's a membership for that too

Not every nurse reading this is starting from scratch. Plenty of you already run your own practice and already pay for a medical director somewhere. If that's you, a lot of what's above is stuff you sorted out a while ago, and Five Square has a leaner membership built for exactly your spot. California is on the Five Square expansion roadmap, and in most new states the Established Nurse Membership opens first, so if you already run a practice, you're likely first in line.

It's called the Established Nurse Membership. It's $799 a month, month to month, no annual lock. You get a medical director who's actually engaged, a compliant structure in California, vendor and product pricing, the Five Square Nurse Community, and those instant on-demand Good Faith Exams at $19.99 each, a price we subsidize for our members because we believe in nurse success. There's no new-injector training folded in, because you don't need it and shouldn't pay for it. If you ever want the full education stack later, you can add it.

Here's the honest pitch. Most established practices are either paying $1,500 to $5,000 a month for a director who's genuinely involved, or a few hundred for one who signs protocols and disappears, which is its own risk when a board comes asking. For most nurses, $799 all in beats both, on price and on what you actually get. Tell us what you're paying now and we'll show you the side by side. No pitch, just the math.

What it costs, and the catch nurses look for

For a nurse starting out, membership is a flat $899 a month for one tier, $1,199 for two, $1,499 for all three, on a 12-month term. Startup beyond that is lighter than people expect: a starter tox order, insurance that runs well under most nurses' guesses, and the products you actually use. No revenue share, ever. (Already have a practice? The Established Nurse Membership above is $799 a month, month to month.)

That's usually the moment the skeptical part of your brain asks where the catch is. Fair. So, plainly: you own your practice and your patients through your own LLC. Five Square does not take a cut of what you make, and if a discovery call turns up that the honest answer for you is 'not yet' or 'start smaller,' the team will tell you that too.

California-specific costs to budget for

Articles of Organization for an LLC are $70 with the Secretary of State, and the Statement of Information is $20, due within 90 days and every two years after. A professional corporation is $100 to form plus a $25 Statement of Information every year. The one nobody budgets for is the $800 annual LLC or franchise tax owed to the Franchise Tax Board from year one, due the 15th day of the fourth month of your tax year, with an extra fee once California income passes $250,000. Retail product carries the 7.25% statewide sales tax plus district taxes of 0.10% to 1.50% depending on the city.

So, where do you actually start in California?

You book the call. That's genuinely it. Not a six-month research project, a 15-minute conversation about your license, your goals, and what launching (or leveling up) in California would look like for you. Whether you're brand new or already running a practice, the whole reason Five Square exists is so you're not doing the hard parts alone.

Schedule a discovery call

Common questions about starting a practice in California

Can I just form an LLC for my med spa in California?

No. An LLC can't practice medicine in California, and the Medical Board treats tox, filler, IVs, and prescription protocols as the practice of medicine. The clinical entity has to be a professional medical corporation majority-owned by physicians (Corp. Code §13401.5), with an RN able to hold up to 49%. Your own LLC can still exist as the management company that owns the brand, the lease, and the equipment and gets paid a fixed management fee.

Does the good faith exam have to be in person in California?

No. Bus. & Prof. Code §2242(a) says an appropriate prior examination doesn't require a synchronous interaction and can be done through telehealth, including a questionnaire or self-screening tool, as long as the standard of care is met. What can't change is who does it: a physician, or an NP under standardized procedures. The Medical Board says that exam may not be delegated to an RN.

What's a 104 NP and does it matter for my practice?

A 104 NP is a nurse practitioner certified under Bus. & Prof. Code §2837.104 to practice without standardized procedures outside a group setting. It takes 4,600 hours of transition-to-practice plus three years as a 103 NP, and the BRN only opened applications in 2026, so there are very few of them. If you're an NP on that path it may eventually change how your practice is structured. For an RN starting today, plan on a physician as medical director.

Can a registered nurse own a med spa in California? Not outright. California has the strictest corporate practice of medicine rule in the country, and the Medical Board applies it to med spas by name.

Do I need a medical director for aesthetics in California? Yes. California requires oversight for medical aesthetic services, and every Five Square practice includes a medical director as part of the membership.

Can a nurse do Botox in California? Yes, within a compliant structure and with the physician oversight California requires. The clinical work is rarely the barrier; the structure around it is.

I already run a practice in California. Can Five Square still help? Yes. The Established Nurse Membership is built for nurses who already have a practice: $799 a month, month to month, with a medical director, a compliant structure, vendor pricing, and $19.99 on-demand Good Faith Exams. No new-injector training you don't need, and no annual lock.

How much are Good Faith Exams? For Five Square members, simple Good Faith Exams are $19.99 each, on demand, seven days a week, a price we subsidize because we believe in nurse success. One exam can clear a patient for several treatments at once, and the documentation attaches right to the patient's chart.

Is Five Square available in California yet? California is on the Five Square expansion roadmap, and in most new states the Established Nurse Membership opens first. The fastest way to get the timeline and hold your spot is a discovery call.

How much does it cost to start? For a new nurse, membership is $899 a month for one tier, and startup beyond that (a tox order, insurance, products) is lighter than most nurses expect. If you already run a practice, the Established Nurse Membership is $799 a month, month to month. No revenue share either way.