Opening a chiropractic practice means making dozens of business decisions that chiropractic school typically doesn't prepare you for. Funding, software, marketing, reviews, and your first patients. So which decisions matter most, and which ones can wait?
In our webinar, Launching a Chiropractic Practice in 2027: How to Build the Right Foundation from Day One, SKED founder and Higher Health Chiropractic owner Dr. Erik Kowalke sat down with Dr. Jesse Ventoso of Active Family Wellness and Dr. Erin Ventoso of Willow & Sage Wellness Co. The Ventosos opened their New Jersey practice together in 2020, just as COVID caused practice shutdowns. They shared what they're glad they did, what they'd do differently, and what they'd do if they were opening today.
Planning your chiropractic practice opening? Get the free Practice Launch Toolkit. This interactive guide covers everything from licenses and choosing an EHR to getting found locally and your first 30 days.
Here are the biggest takeaways from the webinar.
1. Build Your Chiropractic Practice Foundation Before You Open
The work you do months before opening day sets the tone for everything after it. Here are three places that need attention before your practice opening:
- Get your funding in place before you sign a lease. An approved loan isn't the same as money in your account, and Small Business Administration (SBA) loans take time. Know exactly where each dollar is going, beyond the spreadsheet in your business plan.
- Stay flexible. No plan survives first contact with reality. The Ventosos signed their lease on February 1, 2020. Six weeks later, COVID changed everything, and their build-out paused. They pivoted to home visits and learned social media marketing on the fly to adapt to the new reality in a lockdown world.
- Start building your online presence early. You can set up your Google Business Profile, social media pages, website, and photos long before you open. The Ventosos started more than nine months before they graduated, as students. Search engines and AI tools look for this kind of information when people search for a chiropractor, and building a digital reputation takes time.
"I feel like everybody waits until you have all of your ducks in a row, but it's okay to build it out as you're going."
– Dr. Erin Ventoso
2. Don't Cut Costs on the Tools That Drive Revenue
Keeping overhead low makes sense when you're opening a practice, but some savings end up costing you more than they save.
Your EHR is not the place to go cheap for long-term cost savings. When the Ventosos opened, they chose the least expensive EHR they could find. It was a generic system, not one built for chiropractic. They struggled to link family profiles, make sure charges were correct, and track everything, so they ended up managing about 10 different spreadsheets by hand. Looking back, they estimate that the lack of automation left tens of thousands of dollars on the table.
Do the math on what a tool is worth. Say your average visit brings in $40. If your software helps just five more patients show up each week, that's about $800 a month in revenue. Saving $100 a month on software that can't do that is a bad trade for profitability.
"If whatever you're looking to cut costs on could affect patients showing up, you've got to think really hard about saving a hundred bucks to lose $5,000."
– Dr. Erik Kowalke
Get help with insurance billing. One wrong setting can be costly. Early on, one unchecked box in Dr. Erik's EHR meant his practice went months without Medicare reimbursement. Billing experts cost money, but you'll get paid faster and more reliably.
Save money where it won't hurt revenue. Your website is a good example. AI website builders make it easier and cheaper than ever to build a site yourself. Spend your money on the things that directly affect revenue and patient show-up: billing, your EHR, scheduling, and patient communication.
3. Getting Found Locally: Reviews, Profiles, and Fewer Clicks
Online reviews are often the first impression a new patient has of your practice. According to BrightLocal's 2026 Local Consumer Review Survey, 97% of consumers read reviews for local businesses, and 71% use Google to read them. Yet ChiroHD's State of the Chiropractic Industry report found that 28% of clinics have fewer than 25 Google reviews.
Start collecting reviews before you graduate. Your reviews can be about you as a doctor, not just your practice. Aim for at least 15 Google reviews from people you've cared for in student clinic and your internships. If your Google Business Profile isn't set up yet, collect their contact information now and send them a link once it's live.
Ask for a full story on your Google reviews, not just stars. Detailed reviews help with search and with how AI tools describe your practice. You can also screenshot your best reviews and reuse them on your Google Business Profile and website. Photos matter too, so add plenty. Make sure the photos are HIPAA-compliant.
Make it easy to leave a review by removing unnecessary clicks. Every extra step you ask someone to take means fewer people finish. When Dr. Erik's office sent review requests that required several clicks, only 0.6% of patients left a review. When they switched to a direct link that opens Google's review window with the stars already filled in, that jumped to 6.8%. The same rule applies to new patient forms, email signups, and everything else.
"Just reduce every click you can. Make it as simple and convenient as possible."
– Dr. Erik Kowalke
Don't wait to set up your EHR and patient communication solutions. The earlier your systems are set up, the sooner they can start working for you. Your EHR and patient communication tools can do much more than SOAP notes and billing. Set them up months before you open to start building an email list and capturing interest as you meet people. You can even practice checking in patients as a student, so you're comfortable with the software on day one.
4. How to Open Your Chiropractic Practice with a Full Schedule
Your goal should be to open with a full schedule of new patients in your first week. Online marketing will pay off over time, but someone who has never met you may need 7-10 touches before they book via online channels alone. Meeting people face-to-face builds trust much faster and can help fill the books for your week 1 opening. Here are a few tips to help fill the schedule:
- Be everywhere. Screenings, community events, chamber of commerce, networking groups, and ribbon cuttings. Just stay busy and visible. Connections you never planned for will start to organically happen.
- Find where your ideal patients gather online. If you want a family practice, join local parent groups. Answer questions and offer value without expecting anything in return. Over time, people will recognize your name and see you as a resource.
- Let referrals grow your practice. Dr. Erik had zero patients booked on the Friday before opening. One screening that weekend filled his first week with 13-15 new patients. Within three weeks, his practice was seeing 100 visits a week as those patients brought in their families. The Ventosos saw the same effect. Their home visits during the COVID build-out pause turned into 60 patients on opening day.
"There's enough people that need good chiropractic care. There's a lot of spines out there."
– Dr. Erik Kowalke
When you don't feel like going to one more event, ask yourself: if the first chiropractor in town to reach 300 visits a week won a million dollars, would I go? If the answer is yes, go.
5. Choosing the Right EHR for a New Chiropractic Practice
When choosing an EHR, price should not be your top priority. Focus on these instead:
- Scheduling and patient communication. The patient experience matters most. Look for automations that feel personal. For example, a two-way text sent a few minutes after a missed appointment that says "Are you on your way?" from your front desk gets patients to respond and engage. That kind of personal touch improves retention and referrals. It's how SKED was designed to work.
- One connected system. You can piece together separate tools for scheduling, campaigns, and marketing, but then you're the one making sure everything is connected and running reports across multiple systems. Keeping it all in one place saves you time.
- Built-in reporting. Track your key numbers, like new patients and patient visit average, from day one. If your EHR doesn't give you those numbers, you'll end up pulling them by hand. With reporting built into an EHR like ChiroHD, it's easy to review your stats in team meetings.
"We knew what we were doing, and we knew how to do it, but we didn't know how to track it."
– Dr. Jesse Ventoso
Final Takeaway from Each Speaker
Dr. Erin Ventoso: Trust yourself. You never know who you'll meet or where a connection will lead. You won't always feel motivated to get out there, but it's always worth it.
Dr. Jesse Ventoso: Get involved, whether that's clubs, Facebook groups, or community events, and don't stop. It pays off if you put in the work.
Dr. Erik Kowalke: Get as much experience as you can before you open. Spend time with the offices you want to emulate, then get out and meet people. Hard work is your biggest lever for success.
Watch the Full Webinar
Missed it live or want to rewatch? Watch the full recording above, and get your free Practice Launch Toolkit to start checking off your opening-day list.