Most of what decides whether a medical office opens on time is settled before construction starts. This checklist follows the order those decisions actually need to be made in, from the first look at a space through the day you see patients.
Before you sign the lease
- Walk the space with a contractor and your architect. What is under the floor and above the ceiling matters more than the floor plan.
- Confirm the building allows your use — medical use, plumbing-heavy work, after-hours construction, and any imaging or medical gas.
- Read the building rules attached to the lease: approved contractors, insurance limits, freight hours, work-hour restrictions.
- Compare the tenant improvement allowance to a realistic budget. Allowances are usually sized for ordinary offices.
- Negotiate a construction period that reflects permitting and the building's review time, not just the build.
Design and pre-construction
- Lock the room count and workflow — exam rooms or operatories, sterilization or clean/soiled utility, lab, consult, staff areas.
- Order the equipment early enough to get rough-in drawings. Plumbers and electricians build from the vendor's templates.
- Decide who supplies what: casework, sinks, appliances, IT, signage — contractor or practice.
- Complete the drawings before bidding. Gaps in drawings return as change orders.
- Ask for proposals broken out by trade so you can compare bidders line by line.
- Confirm accessibility — routes, restrooms, reception counter heights, door hardware.
Permits and approvals
- Building department filing by the architect or expediter.
- Landlord review and approval of the drawings and the contractor's insurance.
- Special inspections identified and scheduled.
- Any agency approvals specific to your practice — imaging registration, medical gas verification — assigned to a named person.
During construction
- One weekly meeting, one set of minutes.
- Owner access to the project record. PBS gives clients access to the job in Procore: daily reports, photos, RFIs and schedule.
- Verify rough-in dimensions against the equipment templates before walls and floors are closed.
- Approve finishes from physical samples, not screens.
- Track long-lead items — doors, hardware, millwork, specialty lighting, HVAC equipment — from the first week.
Before opening day
- Punch list walked and closed with the contractor and architect.
- Inspections signed off and the paperwork needed to occupy the space in hand.
- Equipment installed, connected and tested with the vendor.
- IT, phones, security and payment systems live.
- Closeout package received: warranties, as-built information, operating manuals, final lien waivers.
- Staff trained in the new space before the first patient.
Where PBS fits
Principal Builders Solutions builds medical and dental offices as a general contractor — see the practices we have completed on our medical office construction and dental office construction pages. If you are early, send us the address and what you have in mind and we will tell you what to look for in the space.
