# Medical Office Buildout Checklist: From Lease to Opening Day

*Published September 21, 2026 by PBS Editorial Team — Principal Builders Solutions Inc.*

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](https://www.pbsny.com/medical-office-construction) and [dental office construction](https://www.pbsny.com/dental-office-construction) pages. If you are early, [send us the address and what you have in mind](https://www.pbsny.com/contact-us#send-a-message) and we will tell you what to look for in the space.

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*Principal Builders Solutions Inc. — 350 Jericho Turnpike, Suite 104, Jericho, NY 11753 — (516) 584-2117 — info@pbsny.com*

*Canonical page: https://www.pbsny.com/post/medical-office-buildout-checklist*