1. The short answer, and what moves it

A solo cash-pay telehealth practice can realistically open in 60 to 90 days if licensing is already in hand, and 90 to 120+ if it is not. Nothing about the software is what decides this. Software onboarding is measured in weeks and can be compressed; state licensing, DEA registration, payment underwriting and number porting cannot.

The single most useful thing you can do on day one is start every long-lead item at once, in parallel, before you have chosen anything else. Founders reliably do the opposite: they spend the first month choosing an EHR, which is the step with the shortest lead time on the list.

2. The steps with hard lead times

These have external clocks. You cannot shorten them by working harder, so they should all be started in week one regardless of how unready everything else is.

Step Typical lead time Start it when
State licensing Weeks to months Immediately. In a new state this is almost always the binding constraint, and compacts reduce paperwork more than they reduce waiting.
DEA registration Weeks As soon as you hold the state licence it depends on. $888 for three years.
LegitScript certification ~2 weeks+ Before you approach a processor, not after they ask. Expedited review exists at an additional $2,500 per application if you are already late.
Merchant underwriting Days to weeks After LegitScript. High-risk boarding is a real review with KYC and bank underwriting, not a sign-up form.
Porting an existing fax number 2 – 4 weeks Day one, if you are keeping a number. There is no API for porting at any provider — it is a Letter of Authorization, a recent carrier bill and a wait. A brand-new number is instant; keeping your old one is not.
Malpractice binding Days to weeks Early. Some carriers will not bind until the licence is issued, which chains it behind the longest item on the list.
EHR onboarding 1 – 3 weeks Whenever you like. This is the compressible one.
Website 2 days – 90 days Depends entirely who builds it. A template-based site is days. A bespoke agency build is the 60–90 day figure people quote, and it is usually not on the critical path for seeing patients.

3. What runs in parallel

Almost everything else. Entity formation, EIN, NPI, bank account, choosing and configuring software, writing your intake and consent forms, building protocols, setting pricing and memberships — none of these wait on each other and none have an external clock.

This is the part founders underestimate in the other direction. Configuration work feels like it should take weeks and mostly takes days; it is the forms and the waiting that take months.

One genuine exception: if you are migrating from an existing EHR, add time for the export. What actually governs that is what your current vendor will hand over and how quickly, not what the new platform can import. Establish the export before you fix a switchover date — we cover the traps in switching EHR without losing patient data.

4. A realistic 90-day shape

Not a prescription — a shape, for a solo prescriber with licensing already in hand.

Window What is happening What is waiting
Days 1 – 14 Entity, EIN, NPI, bank account. Submit LegitScript. Start the fax port. Choose the platform and begin onboarding. DEA, LegitScript review, port request.
Days 15 – 45 Configure: services, pricing, memberships, intake and consent forms, protocols. Website build. Staff training. Merchant underwriting, port completion.
Days 46 – 70 Dry runs with friends and family as test patients — book, intake, consent, charge, chart, prescribe end to end. Fix what breaks. Any licence still outstanding.
Days 71 – 90 Soft launch to a small real cohort. Then open properly. Nothing, if the above was started in week one.

5. The three things that most often push the date

Payment underwriting started too late. Founders treat the merchant account as a sign-up at the end. It is a review, it can come back with questions, and if LegitScript has not been started first it cannot even begin. This is the most common cause of a clinic that is otherwise ready and cannot take money.

Number porting started in week ten. If you are keeping a fax or phone number, it needs two to four weeks and a paperwork match against your existing carrier’s records. A mismatch in your business address restarts the clock.

Waiting for the website. A bespoke site is genuinely a 60–90 day project, and clinics routinely hold their launch for it. You do not need it to see your first patients — you need a way to book, intake, consent and charge. Launching to a small cohort on a template while the real site is built is almost always the right call.

6. Frequently asked questions

How long does it take to open a cash-pay clinic?
60 to 90 days if your state licensing is already in hand, and 90 to 120+ days if it is not. Licensing, DEA registration, LegitScript certification and merchant underwriting are the steps with external lead times; software configuration is not the constraint.

What is the longest lead time?
State licensing in a new state, usually by a wide margin. After that, LegitScript certification at roughly two weeks and merchant underwriting behind it, and porting an existing fax or phone number at two to four weeks.

How long does EHR onboarding take?
One to three weeks for a new practice with no data to migrate, because there is no export step. Aminova runs three structured sessions and can compress them if you are ready to move faster. If you are migrating from an existing EHR, the governing factor is what your current vendor will export and how quickly.

Can I open before my website is finished?
Yes, and most clinics should. You need booking, intake, consent, charging and charting to see a patient. A bespoke agency website is a 60 to 90 day project that rarely sits on the critical path, and holding a launch for it costs real revenue.

What should I start on day one?
Every item with an external clock, simultaneously: state licensing, DEA registration, LegitScript, and any number you intend to port. These do not depend on each other and cannot be compressed later.