How to Open a Nurse-Owned Practice in Virginia

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. Virginia gives you Northern Virginia paychecks, Richmond neighborhoods, Hampton Roads military families, and a whole lot of counties where the closest injector is still an hour away. That spread is good news for a nurse who wants to be the local option. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in Virginia 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 Virginia nurse asks first.

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

Yes, with the right setup. Virginia lets professional services be rendered through a plain LLC, not only a professional one (Va. Code §13.1-1101.1), and the professional LLC statute lists advanced practice registered nurses without listing registered nurses at all (Va. Code §13.1-1102(A)). So an RN's practice in Virginia is a standard LLC with the clinical work furnished by licensed providers. The statutes don't spell out RN ownership in so many words, which is why Five Square builds the entity and the medical director relationship for you instead of handing you a template.

The Virginia rule that catches almost everybody: Schedule VI

Virginia has a drug schedule no other state has. Schedule VI sweeps in every drug or device carrying the federal "Rx only" legend (Va. Code §54.1-3455), so neurotoxin, dermal filler, and GLP-1s are all "controlled substances" here, even though nowhere else would call them that.

The consequence lands on the initial patient evaluation, which some states call a good faith exam. Virginia's term is a "bona fide practitioner-patient relationship": a history, a risk and benefit conversation, an appropriate examination, and follow-up if needed (Va. Code §54.1-3303(B)). For a controlled substance, and that's tox here, the exam has to be performed by the prescriber, someone in the prescriber's group, or a consulting practitioner. It can't be handed to you as the RN. Telehealth is allowed with conditions, including a diagnosis made by the prescriber at that visit. An intake form on its own doesn't get there.

The surprise runs the other way too: once the relationship exists, the prescriber can authorize an RN or LPN to approve up to 90 consecutive days of Schedule VI refills under a written protocol, as long as drug, strength, and dose don't change (Va. Code §54.1-3303(K)).

Who can be your medical director in Virginia

An NP can, and so can a physician. Virginia isn't a full practice authority state at licensure. An NP practices under a practice agreement with a patient care team physician until they qualify for autonomous practice (Va. Code §54.1-2957(C)), and the threshold is three years of full-time clinical experience at 1,800 hours a year, so 5,400 hours (18VAC90-30-86(A)). You'll see 4,500 and 9,000 online. Both are wrong as of the November 2024 amendment.

An NP director under 5,400 hours has a physician behind them on paper, which doesn't put anyone in your treatment room. If your director is a physician, the only written Board of Medicine delegation standard is "readily available" rather than on site (18VAC85-20-91(E), the laser hair removal rule). We found no on-site presence requirement for injectables in Virginia statute or regulation.

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 Virginia 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

"As a nurse, taking risks is not in our vocabulary. Five Square made me excited about starting my own business. Timely responses, professional, highly knowledgeable, and a team that wants to see me succeed. I say my risk was absolutely worth it."
- Patricia G., 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 Virginia? 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. In Virginia, you can join whether you're just starting out or already running a practice.

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 Virginia, 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.

Virginia-specific costs to budget for

Forming the LLC is $100 to file articles of organization with the State Corporation Commission, and the annual registration fee is $50, due by the last day of the month you formed the company (so a March LLC pays every March). If you sell skincare or other retail product to patients, Virginia's sales tax runs 5.3% in most of the state and higher in a few regions like Northern Virginia and Hampton Roads, and you'll register with the Department of Taxation for a sales tax account before the first sale.

So, where do you actually start in Virginia?

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 Virginia 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 Virginia

Can my medical director do the first exam by telehealth in Virginia?

Yes, with conditions. Va. Code §54.1-3303 lets a prescriber establish the bona fide practitioner-patient relationship through telemedicine if the patient has provided a reviewable medical history, the prescriber updates it and makes a diagnosis at the time of prescribing, and the standard of care doesn't require an in-person exam for that diagnosis. The exam has to be done by the prescriber or someone in their group. A questionnaire on a tablet doesn't count on its own.

Do I need a PLLC in Virginia, or is a regular LLC fine?

A regular LLC. Virginia lets professional services be rendered through a plain LLC organized under Chapter 12 (Va. Code §13.1-1101.1), and the professional LLC statute doesn't even list registered nurses as eligible owners (Va. Code §13.1-1102(A)). You'll file articles of organization with the SCC for $100 and name a registered agent with a Virginia address. Five Square walks you through the filing as part of setup.

Does my NP medical director need a physician behind them in Virginia?

Unless they've qualified for autonomous practice, yes. Virginia requires a practice agreement with a patient care team physician until the NP completes 5,400 hours of full-time clinical experience over at least three years (Va. Code §54.1-2957; 18VAC90-30-86). That's the NP's paperwork to carry, and it doesn't put anyone in your treatment room. It just means the oversight chain is a little longer than it would be in a full practice authority state.

Can a registered nurse own a med spa in Virginia? Yes, with the right setup. Virginia lets professional services be rendered through a plain LLC, not only a professional one (Va.

Do I need a medical director for aesthetics in Virginia? Yes. Virginia 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 Virginia? Yes, within a compliant setup and with the oversight Virginia requires. The clinical work is rarely the question; it's whether the practice around it is built legally.

I already run a practice in Virginia. 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 Virginia? Yes. Five Square already supports nurses in Virginia, so a discovery call is about your timeline and your goals, not whether we're there yet.

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.