How to Open a Nurse-Owned Practice in District of Columbia

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. The District is dense, walkable, and full of people who budget for self-care the way other cities budget for parking, and a practice in Navy Yard, Dupont, or Petworth can fill a book from a few blocks' radius. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in District of Columbia 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 District of Columbia nurse asks first.

Can a nurse own an aesthetics, wellness, or functional health practice in the District of Columbia?

Yes, with the right setup, and DC is the one place where the answer comes with a footnote. No DC statute bars a nurse from owning an LLC that delivers nursing services, and the professional corporation chapter is optional (D.C. Code 29-503). The footnote is Board of Medicine Policy 15-02 (November 13, 2014), which defines a medical spa as an entity "owned by, or an organization of which the majority shares are held by, a physician(s) licensed in the District." The policy says of itself that "until the Board promulgates these regulations, the following policy is a directive in nature and not mandatory," and we couldn't find any such regulations.

The DC rule that catches almost everybody: a physician-owned, physician-present policy that isn't a rule

Policy 15-02 sorts aesthetic work into three levels. Level I is esthetician work like superficial peels. Level II is non-ablative lasers and deeper peels. Level III is the list you care about, injectables including neuromodulators and fillers, which the policy says "may be performed only by persons authorized to practice medicine under D.C. Official Code 3-1201.02(7)." A Level III facility's medical director, a physician, should be "physically present in the facility for at least fifty (50) percent of the hours of operation" each week (section 1.15).

Two things soften that. The policy is non-mandatory by its own terms, and it never once mentions a nurse or an advanced practice registered nurse; it was written for a physician-only world DC law left behind in 2024. Honestly, this is the state where you want Five Square's compliance team and DC counsel on the structure before you order product.

Can an APRN be your medical director in DC?

Yes, and independently. The Health Occupations Revision General Amendment Act of 2024 (D.C. Law 25-191, effective July 19, 2024) repealed the collaboration requirement at D.C. Code 3-1206.03 and added language that a certified nurse practitioner "may provide a full range of primary, acute, and specialty healthcare services," including diagnosing, treating, and prescribing (D.C. Code 3-1206.07a). Whether an APRN-directed practice is even a "medical spa" under a policy that only talks about physicians is the open question. That's the footnote.

The initial patient evaluation in DC

DC has no rule naming who performs the initial patient evaluation, which some states call a good faith exam, and none on telehealth. An RN implements "regimens requested, ordered or prescribed by authorized health care providers" (17 DCMR 5414.1(d)), so the evaluation and order belong to your APRN or physician.

One that surprises people: DC's biennial LLC report is $300 with a flat $100 late fee (DLCP fee schedule).

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 District of Columbia 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:

"Five Square is the reason I was able to launch my career as an aesthetic nurse injector. From setting up my LLC and making sure I'm compliant in my state, to a dedicated medical director, weekly live calls with experts, and a huge network of nurse entrepreneurs, it was the best decision I made."
- Krystle N., 5-star Google review

"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 District of Columbia? 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. The District of Columbia 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 District of Columbia, 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.

DC-specific costs to budget for

Filing Articles of Organization for an LLC with the Department of Licensing and Consumer Protection is $99. The bigger line is the biennial report at $300, due April 1 every two years, with a $100 late fee if you miss it. DC also requires a Basic Business License for most businesses operating in the District, which is a separate application with DLCP. If you sell retail product to patients, the District's general sales tax is 6 percent and you'll register with the Office of Tax and Revenue before your first sale.

So, where do you actually start in District of Columbia?

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 District of Columbia 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 District of Columbia

Does DC require a med spa to be owned by a physician?

Not by statute. The DC Board of Medicine's Policy 15-02 (November 13, 2014) defines a medical spa as physician-owned or majority physician-held, and asks for a medical director who is a physician on site 50 percent of operating hours. The policy states that until regulations are promulgated it "is a directive in nature and not mandatory," and it predates the 2024 law giving APRNs independent practice. Treat it as the Board's stated preference, get DC counsel on the structure, and don't assume it will never be enforced.

Does my medical director need a collaboration agreement in DC?

Not anymore. D.C. Law 25-191, effective July 19, 2024, repealed the collaboration requirement that used to sit at D.C. Code 3-1206.03. A certified nurse practitioner now provides "a full range of primary, acute, and specialty healthcare services," including prescribing, on their own license (D.C. Code 3-1206.07a). An APRN director in DC carries no physician paperwork behind them.

Can an LPN inject Botox in DC?

DC hasn't published a position on it. The Code defines practical nursing as directed services performed "under the supervision of a registered nurse, advanced practice registered nurse, licensed physician, or other authorized health care provider" (D.C. Code 3-1201.02(15)), and the Board of Medicine's 2014 policy treats injectables as Level III procedures reserved for those authorized to practice medicine, without addressing nurses at all. Until the Board of Nursing speaks, an LPN injecting in DC is a question for counsel, not a plan.

Can a registered nurse own a med spa in District Of Columbia? Yes, with the right setup, and DC is the one place where the answer comes with a footnote. No DC statute bars a nurse from owning an LLC that delivers nursing services, and the professional corporation chapter is optional (D.C.

Do I need a medical director for aesthetics in District of Columbia? Yes. District of Columbia 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 District of Columbia? Yes, within a compliant structure and with the physician oversight District of Columbia requires. The clinical work is rarely the barrier; the structure around it is.

I already run a practice in District of Columbia. 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 District Of Columbia yet? District Of Columbia 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.