1. What are the membership shapes?

Six, and the choice is really about which risk you are willing to carry.

Shape What it solves The risk you take on
Access fee — a monthly fee for the relationship, services priced separately Predictable revenue with almost no delivery exposure. The member sees no obvious value in a quiet month and cancels. The fee has to buy something nameable.
Included service — one treatment a month Simple to sell, and it guarantees a visit. The heavy user. Price it against a member who comes every single month, not the average.
Credits or units — a monthly allowance spent across the menu Flexibility, and it fits a multi-service clinic. ⚠️ Rollover. Unlimited carry-forward is an unlimited package sold by accident.
Member pricing — a fee that unlocks a discount Rewards the frequent customer without giving anything away. Perceived value is thin if they visit rarely. Works best beside a second, richer tier.
Programme — a fixed-term course billed monthly The clinical shape: a defined start, middle and end. It ends. A clinic living on programmes is re-selling every few months.
Tiered — two or three of the above stacked Captures both the occasional and the committed member. Complexity at checkout. If staff cannot state a member’s price without looking it up, the tier is theoretical.

2. The terms that have to exist before the first charge

⛔ The agreement comes before the money. Always. A recurring charge without agreed terms is the single most expensive shortcut in this model — it is also the one that is invisible until a member disputes a charge, and then it is the only thing that matters.

Term What it has to say What goes wrong without it
What is included Precisely which services, how many, at what cadence. “I thought that was covered” — at the desk, in front of other patients.
Rollover Whether unused units carry, and for how long. A member returns after six months expecting six treatments.
Term and renewal Month to month or a committed term, and how it renews. Auto-renewal rules are state law. An unclear renewal is where the consumer-protection exposure sits.
Cancellation Notice period, and what happens to unused credit. Every dispute you will ever have is about this sentence.
Pause Whether it exists, for how long, and what it does to credits. Without a pause, a member who travels cancels instead. Retention lost to a missing clause.
Price changes How and with what notice. A clinic that cannot raise prices has priced for the last three years forever.
⛔ Suspension for non-payment That benefits stop while a payment is outstanding. Otherwise a failed card buys free treatment until somebody notices.

Stored with the member, dated, and versioned — the terms someone agreed to in March are the terms that govern them, not whatever is on the website today.

3. What a membership actually does to the money

Two things, and only one of them is obvious. The obvious one is predictability. The second is that a membership changes who your clinic is for: it rewards frequency, which means the menu has to have something worth coming back for.

Number to know How to think about it
Cost of the included service at full utilisation Price against the member who uses everything, every month. If that member loses you money, the programme is a bet on apathy.
Breakage ⚠️ Unused credit is not profit — it is a liability until it expires or is used, and in some states it may not expire at all.
Churn A programme with 8% monthly churn replaces its whole book in a year. Measure it from the start; it is the number that decides whether the programme works.
Failed payments Cards expire constantly. Without retries and a suspension rule, the first sign is a quiet revenue drop nobody attributes to anything.
⭐ The second month The gap between month one and month two is the truest signal you have. Everything before it is sales; everything after it is the programme.

4. What the software has to do

A membership is not a subscription with a nice name. It is an entitlement that has to be checked at the point of service.

Requirement Why it matters at the desk
Entitlement visible at checkout Staff must see what this member is owed today without asking anyone.
Units that decrement when used Not when booked. A cancelled appointment must not eat a credit.
The agreement stored against the member, versioned The terms they accepted, not the current ones.
Retry and dunning on failure A card decline is an event with a process, not a surprise at month-end.
Suspension that actually blocks benefits ⛔ The rule is only real if the system enforces it.
Pause and cancel without a support ticket Friction here converts a pause into a cancellation.
Multiple plans per patient A member can hold a treatment membership and a programme at the same time. A system that allows one will be worked around with spreadsheets.

If most of the membership is a recurring drip or injection, the operating side is in running an IV therapy clinic. The payment rail matters too — a membership that includes medication cannot settle on a processor whose terms ban it: which processors allow prescription clinics.

5. Frequently asked questions

Should unused membership credits roll over?
Decide deliberately and write it down. No rollover is cleanest and feels harsh in a month where a member was ill; unlimited rollover is an unlimited package sold by accident. Most clinics land on a capped carry-forward — one or two months — which has to be enforced by the system rather than remembered at the desk.

How do I price an included-service membership?
Against full utilisation. Take the member who uses everything every month and check that they are still profitable; the average member is not the one who will test your pricing. If full utilisation loses money, either the included service is too rich or the fee is too low.

What happens when a member’s card fails?
Retry on a schedule, tell them, and suspend the benefits while it is outstanding. The failure mode without a suspension rule is straightforward: treatment keeps being delivered against a payment that never arrives, and it is usually discovered at month-end.

Do I need a signed agreement, or is a checkbox enough?
What matters is that the terms were presented and accepted before the first charge, and that you can produce what they accepted and when. Whether that is a signature or a recorded acceptance is a question for your counsel and your state — but agreeing after the money has moved is not an option in either.

Can a patient hold more than one membership?
They should be able to. A weight-loss programme and a monthly treatment membership are different products with different terms, and a system that supports only one per patient ends up being worked around in a spreadsheet — which is where entitlements go to be forgotten.