How To Open A Cold-Start: Step By Step Guide

Introduction

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This comprehensive checklist is a fantastic resource for optometrists looking to start their practice from scratch. It covers a wide range of topics, from location and financing to equipment and marketing. By following this guide, optometrists can ensure they have all the necessary tools and resources to launch a successful practice. Whether you're a seasoned professional or just starting out, this checklist will be an invaluable tool in your journey to establishing a thriving optometry practice.

  • This list is divided into four parts. While it makes sense to follow this checklist chronologically, it's not mandatory. Please remember to check all state and county regulations while going through this checklist.

  • Part 1- Location/Financing

  • Part 2-Business Operations

  • Part 3-Shopping List

  • Part 4- Equipment/Optical

Part I - Location/Financing

(1) ✅  Determine a location

  • Evaluate: population, number of providers, demographics, household income, education level, industry, prevalence of insurance/vision plans, and geographical “deserts”.
  • Use CARR for site analytics to find the best location.
  • Resource: Practice Transitions

(2) ✅  Decide on building purchase vs. lease

  • Calculate monthly cash flow impact.
  • Understand current interest rates for ownership vs. lease.
  • Consider the pros and cons of commercial real estate (CRE) ownership.

(3) ✅ Draw up terms on location

  • Draw up terms on location
  • For leasing, negotiate length and terms. Consider consulting an attorney like Ali Oromchian, JD or a specialized firm like CARR.
  • For ownership, consult your lender and possibly a real estate attorney.
  • Resources: Legal Services

(4) ✅ Assess the Build Out

  • Most likely, a build-out will be needed to convert a space into an optometry office.
  • Contact FrameDisplay or OMG Optical (use the ODs on Finance discount) for guidance.
  • Plan the costs and timing. It might need to be phased based on your timeline. While it might be tempting to DIY, for bigger projects like this - it is better to hire an expert.

(5) ✅ Obtain Financing

(6) ✅ Hire an Expert Consultant 

  • Starting an optometric practice is challenging. Even with resources, you need expert guidance. Rick Guinotte, Tim Merrigan, and the Acquios Advisors team offer experienced advice at a minimal monthly fee, no commitment, and without the $20-30K upfront charges.

  • Resources: Practice Consultants 

Part II - Business Operations

(1) ✅ Business license 

  • Contact the City you are located in and apply for business license

(2) ✅ Register for a DBA: 

  • Step 1: Check name availability in California. Make sure your DBA is not in use.
  • Step 2: File a Fictitious Business Name Statement at the county clerk's office.
  • Step 3: Publish the new name in a local newspaper→ you will need to contact some local newspaper to get this set up for you → Google “DBA in County” and you will get a list of options to choose from
  • Step 4: Pay the Fees

(3) ✅ Once you have your DBA/fictitious business name 


(4) ✅ Add/change place of practice


(5) ✅ Get business liability insurance + property insurance

  • You will need property insurance to insure any of your equipment that you own
  • Greg Bellamy @Professional Plans - highly recommended and his rates are very competitive compared to AOA as he works with only Optometrists!

(6) ✅ Establish Your Corporation + Establish a Group NPI

  • Consult with your CPA to establish your corporation, S Corp is what is recommended by most CPA
  • Resource: Recommended list of vetted OD-focused CPA
  • Set up a Business Checking account with your Corporation Name
  • Sign up for Business Credit Cards

(7) ✅ Sign up for ODoF Merchant Services 


(8) ✅ Get credentialed with insurance before you open as it will take months!

  • VCP: Spectera, VSP, MES, Davis, Eyemed, IEHP, Medical, Superior, Avesis etc
  • Medical: Medicare, Triwest, BCBS, Anthem, Aetna, Cigna, Humana, UHC
  • Note: For any credentialing, we use CSeye, and they are very affordable and quick. Julie got her associate onto the Medicare panel in 2 weeks! Highly recommended for fast and professional service.
  • Contact Rob at CS Eye Billing/Credentialing
    • Price is around $200 per panel
    • You can do it yourself, but for the medical plans, we highly recommend letting the pros do it for you. Remember Each month you are waiting = Money Lost.
  • CSEye also does medical billing - so ask them to give you a quote!
  • Practice Pal is an online portal that does Vision + Medical insurance verifications all in one platform and uploads the insurance info into your EHR - saves quite a bit of staff time
  • Tip: While waiting for your credentialing, compile a list of patients who intend to use their insurance. Record their names, phone numbers, and DOBs on a waitlist, and reach out to them once you've been approved by the panel.

(9) ✅  If you’re moving from another location 

  • Update all insurance with your new address

(10) ✅ Website (& Digital Marketing)

  • We can't stress enough the importance of having a website. Ensure you have one set up before your official opening. Both of us use ROYA for our practices. Their websites start at $99/month with reasonable onboarding fees. They have an a great COLD START PROGRAM!
  • They offer affordable, custom designs that aren't generic.
  • For better search engine rankings and increased online visibility, inquire about their SEO package upgrade.
  • Example:
  • Contact: For inquiries, email dani.astilla@roya.com and ASK FOR THEIR LOW COST COLD START PACKAGE
  • Resources: Website & Digital Marketing

(11) ✅ Marketing (Print & Digital Marketing)

  • Julie and Aaron both utilize Done4Y marketing, which is quite affordable at around $899/month. It's especially useful during the initial months of starting out. This fee even includes a website! They handle both digital and print marketing. While many companies charge around $1000/month just for managing FB/Google ads, D4Y offers this service within their flat fee, without binding you to monthly contracts.
  • ASK FOR THEIR LOW COST COLD START PACKAGE
  • Contact: For inquiries,  contact Trish at tolson@marketingd4y.com and mention the ODoF COLD START DISCOUNT
  • Resources: Website & Digital Marketing

(12) ✅ Marketing (DIY)

  • If you are a budget-constrained and  want to DIY, here are some resources we recommend.
  • Make Business Cards / Logo: I use 48hourslogo for my logos. It's priced around $200, and I adore this site! You'll receive designs from 30+ logo designers, turning the process into an exciting contest. You can then select the best design and request revisions until you're entirely satisfied.
  • Printing Business cards: I prefer Vistaprint. Before placing an order, make sure to search for coupons on sites like Coupon Cabin.
  • Professional PhotosConsider getting a professional picture taken to post on your website. If you're looking for a cost-effective option, use your smartphone in bright, natural lighting.

(13) ✅ Add your business to GOOGLE + YELP

  • As soon as you finalize your practice name and location, encourage friends and family who've visited for an eye exam to leave a positive review. It's a fantastic, free marketing strategy!
  • ReviewWave excels at helping you gather reviews. They send automated review requests to all patients, boosting your online presence and potentially making you a top search in your area. Reach out to Matt at matt@reviewwave.com and inquire about the $500 credit, mentioning the ODoF discount.

(14) ✅  Facebook / Instagram  page

  • It's free, so why not set one up? So do it.

(16) ✅ Online Booking Calendar:

  • In today's digital age, online booking is essential. Many people prefer scheduling appointments after regular business hours, making a real-time online booking system crucial.
  • ReviewWave can integrate online booking into your website at no extra charge. Email Matt at matt@reviewwave.com for setup and to integrate automated reviews.

(17) ✅ Online Forms

  • Integrate them with your website and provide a link for all your patients to complete before their visit.
  • Aaron utilizes ReviewWave for this purpose.
  • Again, you can contact Matt at matt@reviewwave.com for setup. ReviewWave also offers a feature to confirm and recall patients via two-way text – a highly beneficial tool.

(18) ✅ Find a Reputable Finishing Lab for Lenses | Frames 

  • GSrx comes highly recommended for its top-quality products and support, coupled with competitive pricing. They are also a VSP lab as well.
  • Reach out to Keith at kposin@gsrx.com or visit GSrx for ODs on Finance.
  • Twelve84 is a high profit margin, high-quality frame/lenses package that can drop-ship anywhere for free, with ZERO inventory investment, cancel anytime. This is great for cold start to compete with Warby Parker online by having a house brand.

(19) ✅ Contact Lens Trials with Vendors


(20) ✅ Contact Lens Solutions and Samples from Vendors

  • Example: Refresh/Systane/Ocusoft/Optase Samples or coupons
  • Optase offers a 21% discount on their products for all ODoF members. Check out their offer here.
  • Additionally, Dry Eye Rescue provides complimentary display cases for practices. Learn more at Dry Eye Rescue for Providers.

(21) ✅ ONLY For Subleases:

  • Inquire if the optical can order CL cases and dilation sunglasses. Some opticals might require you to provide these items yourself. However, Julie's sublease (Sam’s Club) offers these at no cost. It's worth checking with your optical to potentially save on expenses.

(22) ✅ Affiliate with LASIK/Cataract Centers:

  • Reach out to local LASIK/cataract centers to register your office as an affiliate. This allows you to send patients for co-management and earn a professional fee.

(23) ✅ Local networking:

  • Distribute your brochures and referral pamphlets to local OMD/PCP offices, schools, and other relevant places. Go to your local society meeting to promote your speciality to other OD offices around the area.

(24) ✅ Referral Page:

  • Incorporate a referral page on your website. For reference, check out Julie’s page here.

(25) ✅ Staff Training: 

  • Arguably the most crucial step is ensuring your staff is well-trained. Spexy is a fantastic resource for training staff in optical knowledge, sales techniques, billing procedures, and marketing strategies.
  • The cost for their virtual classes is an affordable no contract $42/month. For more details, contact Kayla at kayla@bespexy.com.

Part III: Shopping List Before You Open

✅ Supplies order: We recommend using Optazoom for all your optometric supplies, it is truly the Amazon of optometry for over 40,000+ products all in one place, access to whole-sale pricing


  • Post-its
  • Pens, pencils, erasers, white-out
  • Binders
  • Alcohol wipes and pump bottle (available on Amazon)
  • Tape
  • Tissue boxes and paper towels
  • Organizer for pens and paddles
  • Cotton swabs
  • Stapler and staples
  • Clipboards
  • Mirror for contact lens training
  • Eyeball model (if available)
  • Soap, hand sanitizer, masks (if needed), and soap dispenser
  • Cleaning supplies and Clorox
  • Broom and small vacuum
  • Small fridge and microwave for staff use
  • Laptop, computer monitor, keyboard, mouse, etc.
  • Business bank deposit slips
  • Dilation glasses
  • Glasses cases
  • Custom optical bags / dispensing trays 
  • Lab tools
  • Custom Lens wipes/cleaners/sprays bottles
  • Drops: Propacaine, Tropicamine, Cyclopentolate Nafl strips, Phenyl etc

Part IV: Equipment

⚠️ IMPORTANT: When selecting equipment, it's crucial to stay within your budget. As your practice grows and revenues increase, you can consider adding non-essential equipment.


  Basic Lean Equipment List:

    • Retinal Camera: Whether used or new, it's often more budget-friendly to start with used equipment.
    • Widefield Imaging: Optos or Eidon, this considered standard of care in many practices and can easily be the biggest revenue generator $39 Cash. if you are budget-conscious, the Eidon UWF get as as far out with its 3 image mosaic

Financial Pearl

"For a single exam lane, your out-the-door cost will be approximately ~$50,000. Adding wide-field cameras can increase this by another ~$50,000-120,000."

 Here's the equipment Julie uses at her practice:


  • Optos/Eidon:: Consider reading Dat’s retinal imaging script for better patient acceptance to get over 90%+ Capture rate.

  • Maestro OCT: This is essential, especially if you encounter a significant amount of ocular diseases.

  • RetEval ERG: Clinical indications include conditions like diabetes and AMD, among others. On average, it pays $128 for all testing.

  • Rabin Color Vision: Color vision serves as an early biomarker for conditions like DR, AMD, and glaucoma. It pays an average of $56 per test.

  • Medmont Topographer: Great scans for ortho K

  • Virtual Field/Virtual Vision: This compact equipment is primarily used for glaucoma testing and progression tracking.

  • FireFly Slit-lamp: This is an unparalleled tool for capturing anterior segment pathology with real-time, high-quality photos, videos, and meibography. It's excellent for discussing dry eye products and treatments.

  • Lumenis OptiLight IPL

  • Miboflo: This offers a heat treatment for MGD without the need for consumables.

For eye drops, masks, ointments, wipes, etc.:

  • We utilize Ocusoft and Optase in our practices. If you're subleasing, ensure you check with your store to see if you're allowed to sell drops. Optase offers a 21% discount on all their products, which you can find here.

  • Their products can be showcased using the aesthetically pleasing Dry Eye Rescue displays (mention ODoF Discount), which can be a great conversation starter. If you're unable to sell these products directly, I recommend directing patients to the Dry Eye Rescue online store, where you can earn a commission. To set up an account for online sales, contact Dennis at devans@dryeyerescue.com.

  • For in-office eyelid cleaning, especially for patients with Demodex Blepharitis, Julie uses Zest products.
    • These kits cost around $30 each, and she charges between $220-250 for a treatment, which involves a 5-10 minute eyelid cleaning session. To start an account, you can reach out to Peter at peter.pham@zocular.com.

  • For Tropicamide, proparacaine NaFl, we use Optazoom for all our ordering, think of it as the “Amazon of Optometric Supplies''

Summary

Congratulations, you have officially open up COLD and your dream optometry practice!  Now build it up to its max potential.  Hint, here’s a good place to start to check out all the practice resources from CPA, bookkeeper, 401K and finally lowest pricing on equipment and goods. 


Did that all seem a little crazy and daunting?  Well you’re not alone, starting a practice is one of the biggest financial decisions many ODs make, and with plenty of complicated steps strewn across a stressful timeline, sometimes the journey is just too much to go alone.  That’s where our last KEY RESOURCE comes in: a practice consultant.  They can walk you through the whole process, including formulating APAs and guiding you through necessary paperwork.

Lastly if you can always book a free 30mins consult with Aaron or Jennifer for free guidance or text 📲 PRACTICE to 55444 to get started!

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