Resource Guide

Healthcare Facility Leasing Guide.

A comprehensive guide to leasing medical office space, from initial planning through lease execution.

Why this matters: Healthcare leases require more lead time than typical commercial spaces due to permitting, equipment, build-out complexity, and the need to avoid clinical downtime. Starting early and understanding key terms can save significant time and money.

Planning Timeframes by Facility Type

Facility Type Recommended Lead Time
General medical clinic12–18 months
Dental practice18–24 months
Imaging center24–30 months
Ambulatory Surgery Center (ASC)24–36 months
High-infrastructure specialty18–30 months

Step 1: Review Your Current Lease

Before beginning a search or renewal negotiation, understand your current situation:

  • Lease expiration date and notice periods for renewal options
  • Maintenance responsibilities and compliance obligations
  • HVAC, electrical, and plumbing capacity
  • Parking allocations and ADA requirements
  • Restrictions on imaging equipment, shielding, or sedation
  • After-hours HVAC provisions
  • Clauses related to upgrades or alterations

Step 2: Evaluate Space Needs

Clinical Considerations

  • Exam room count and utilization
  • Provider growth projections
  • Patient flow efficiency
  • Storage, sterilization, and equipment
  • ADA compliance requirements
  • Future specialty services

Infrastructure Considerations

  • Electrical capacity
  • Plumbing requirements
  • HVAC performance
  • Special imaging requirements
  • IT and low-voltage systems
  • Space for future equipment

Step 3: Facility Assessment

Evaluate the physical condition of any space you're considering:

  • HVAC age and performance
  • Electrical panel capacity
  • Plumbing and water lines
  • Flooring and finishes appropriate for clinical use
  • Biohazard waste areas
  • Radiation shielding (if applicable)
  • ADA access and restrooms
  • Parking and patient access

Step 4: Key Lease Terms

Rent Structure

  • Base Rent: The fixed monthly amount
  • NNN (Triple Net): Tenant pays base rent plus share of taxes, insurance, and CAM
  • Full Service/Gross: Landlord includes most expenses in rent
  • Modified Gross: Some expenses included, others passed through

Tenant Improvements (TI)

  • TI Allowance: Landlord contribution toward build-out (typically $30–$100+ per SF for healthcare)
  • Amortized TI: Additional TI funded by landlord and repaid through rent
  • Turn-Key: Landlord delivers finished space to tenant's specifications

Other Key Terms

  • Term Length: Healthcare leases typically 7–15 years
  • Renewal Options: Right to extend at predetermined terms
  • Exclusivity: Protection from competing uses in the building
  • Signage: Building and monument sign rights
  • Parking Ratio: Spaces per 1,000 SF (healthcare needs 4–6+)
  • After-Hours HVAC: Access and cost for extended operations
  • Assignment/Sublease: Flexibility to transfer the lease

Step 5: Build-Out Coordination

Healthcare build-outs require careful coordination of:

Construction Work

  • Plumbing additions
  • Electrical upgrades
  • HVAC modifications
  • IT and low-voltage cabling
  • Medical equipment installation
  • Clinical-grade flooring and finishes

Landlord Coordination

  • Access windows for construction
  • Staging areas
  • Permit requirements
  • Noise management
  • Contractor approval
  • Infection control measures (ICRA)

Step 6: Compliance & Operations

Address these operational items before lease execution:

  • After-hours access and HVAC
  • Janitorial scope for medical use
  • Biohazard and medical waste handling
  • Parking allocations
  • ADA pathways and exam room standards
  • IT and telecom requirements
  • Shielding for imaging equipment
  • Mechanical system performance

Step 7: Lease Execution

Final documentation should clearly address:

  • Lease term and rent schedule
  • TI allowance and delivery condition
  • Timeline for improvements
  • Responsibilities for upgrades
  • Access periods for construction
  • Equipment delivery schedule
  • Communication plan during build-out

Common Healthcare Lease Mistakes

  1. Starting too late — Healthcare leases need 12–36 months lead time
  2. Underestimating TI costs — Medical build-outs cost $100–$300+ per SF
  3. Ignoring infrastructure — Electrical, plumbing, and HVAC limitations can be deal-breakers
  4. Short lease terms — Amortizing build-out costs requires longer terms
  5. Missing exclusivity — Protect against competing practices in the building
  6. Inadequate parking — Healthcare needs more parking than typical office

Need guidance specific to your situation?

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This guide is provided by HealthMed Realty as a general resource. For guidance specific to your situation, contact us for a consultation.