A medical or dental office is one of the most expensive spaces a small practice will ever fit out: dedicated plumbing and vacuum lines, heavy electrical for chairs and imaging, lead shielding, infection-control ventilation, and an ADA-compliant layout. That investment is also what makes the space hard to leave, which is exactly why the build-out, assignment, and restoration terms deserve as much attention as the rent. For the dollar math, see the medical and dental office exposure breakdowns; for general terms, the commercial lease checklist.
This is an observational checklist. Each item names what to find in your lease and why it matters — it does not tell you what to decide. Confirm what your document actually says for each point, and treat any protection that is simply absent as information about where your exposure sits. The legal judgment about what to do with what you find is yours.
1. The Build-Out and Infrastructure Terms
Healthcare fit-outs are specialized and costly, and who pays to install (and later remove) them is the core question.
- Tenant improvement allowance. Confirm the landlord’s build-out contribution, how it is paid, and what happens to unused allowance. Medical and dental fit-outs routinely exceed a standard office TI.
- Plumbing, vacuum, and medical gas. Find which party installs and maintains the dedicated plumbing, suction/vacuum, compressed air, and any medical gas lines a practice requires.
- Electrical load and HVAC. Confirm the space carries the electrical capacity for chairs, sterilizers, and imaging, plus dedicated or after-hours HVAC for equipment and patient comfort.
- Imaging shielding and structural needs. Find who pays for lead-lined walls or shielding for X-ray and imaging rooms, and any floor-load reinforcement for heavy equipment.
- Restoration and surrender condition. Find the condition the lease requires the space to be returned in. Removing shielding, plumbing, and specialized build-out at lease end is a cost most practices never price in. The restoration cost estimator gives a range.
2. The Compliance and Operating Terms
A healthcare practice runs under rules a general office does not.
- HIPAA-compatible layout and access. Confirm the layout and any shared building systems support patient-privacy requirements.
- Biohazard and medical-waste handling. Find which party is responsible for medical-waste storage and disposal logistics and any related common-area rules.
- Permitted use and licensing. Confirm the permitted-use clause covers your specialty and any future scope changes, and which party carries responsibility for permits and the certificate of occupancy.
- After-hours and emergency access. Find whether you have the building access patients and on-call staff need outside standard hours.
- Exclusivity. Confirm whether you have any protection against the landlord leasing to a directly competing practice in the same building.
3. The Money Terms
Base rent is only part of a healthcare tenancy’s cost.
- Lease structure and pass-throughs. Confirm whether the lease is gross or triple-net (NNN), and whether CAM and operating-expense increases are capped. The CAM charges calculator estimates the range.
- Rent escalation and free rent. Find the annual increase and confirm the build-out free-rent period is long enough to cover a lengthy fit-out before rent starts.
4. The Liability and Exit Terms
A practice is hard to move and often sold as a going concern, so these terms are decisive.
- Personal guaranty. Confirm whether you are personally guaranteeing the lease and whether it is unlimited or capped. An unlimited personal guaranty puts your own assets behind the full remaining lease value; negotiated leases commonly include a cap, time limit, or burn-off. The personal guaranty calculator sizes the exposure.
- Assignment on practice sale. Find whether you can assign the lease when you sell the practice or join a group or DSO, and on what conditions, since a restrictive assignment clause can block the sale.
- Early termination and holdover. Confirm any early-termination right and the holdover rent if you stay past the end date. The early termination calculator estimates the exposure.
5. The Dispute Terms
These decide the outcome if the relationship goes wrong.
- Default, cure, and landlord mitigation. Confirm how default is defined, the cure period, and whether the landlord must make reasonable efforts to re-let after a default.
- Attorney fees and jury waiver. Confirm whether fee-shifting is one-way or mutual, and whether you are waiving a jury trial.
- Governing law and venue. Find which state’s law applies and where disputes are heard.
How to use the result: Mark every item you cannot answer from the lease text. The unanswered items are your shortlist for questions, negotiation, or counsel review — and a missing protection is itself a finding, not a blank to ignore. Related reading: medical office and dental practice lease risk by state, and the personal guaranty guide.
Frequently Asked Questions
What should I check in a medical or dental office lease before signing?
Beyond standard commercial terms, a healthcare lease turns on the specialized build-out (dedicated plumbing, vacuum and medical gas, heavy electrical, imaging shielding, infection-control HVAC), compliance items (HIPAA-compatible layout, biohazard and medical-waste handling, licensing), the personal guaranty, the ability to assign the lease when you sell the practice, and the restoration the landlord requires at the end. Confirm each against the lease text before signing.
Who pays for the specialized build-out in a medical or dental office?
It depends on the lease. The landlord typically offers a tenant improvement allowance, but medical and dental fit-outs routinely exceed it, leaving the balance with the tenant. Confirm the allowance amount, how it is paid, and which party owns the improvements and must remove them at lease end.
Can I transfer my office lease when I sell my practice?
Only if the lease allows it. Practices are commonly sold as going concerns or merged into groups and DSOs, so a restrictive assignment clause that lets the landlord withhold consent can block or complicate the sale. Confirm the assignment terms and any landlord-consent standard before signing.
What is the most expensive healthcare lease clause to miss?
For most practices it is the combination of an unlimited personal guaranty and a restoration clause requiring removal of the specialized build-out (shielding, plumbing, equipment) at the tenant’s cost. Together they can convert a practice setback into a large personal liability, and neither appears in the base rent.
Should a medical or dental office lease be reviewed by an attorney?
Healthcare leases combine a personal guaranty, a large specialized build-out, compliance obligations, and a practice that is hard to relocate, so they are commonly reviewed by counsel before signing. A checklist and an automated scan can tell you where the exposure sits; the legal judgment about what to do with that information is yours.