How to set your session fees for a private physio, osteo or chiro clinic

Your session fee should come from what the clinic costs and how many appointments actually happen. Published prices tell you what the market will bear. They don't tell you whether you'll make a living.

The number that moves your fee most isn't rent. It's the share of your slots that end up as attended, paid appointments.

What private clinics charge

There's no national average. TreatCompare, which reads operators' fee pages, says so outright, and only 3 of the 24 physiotherapy operators it tracks publish a readable schedule. Treat them as reference points, not the market.

Length matters. A 30-minute and a 60-minute first appointment aren't the same product, so compare price per minute as well.

I found no equivalent table for osteopathy or chiropractic. I'd ring or check the sites of five clinics within a 20-minute drive. Note the appointment length, and write it down. That's better than any national guide.

Work out the fee you need

Most clinics charge more for a first visit. A £75 first appointment and £51 follow-ups, over a course of six visits, comes to £330, which averages exactly £55. That sits near the published figures outside London, which is a good sign, but your rent and town may say otherwise.

The 44 weeks allows for holidays, CPD, illness and bank holidays. That's my assumption. Self-employed clinicians often forget they don't get paid for any of those.

Fill rate does the heavy lifting

That's a £13 swing with no change to your costs. So before you put your fees up, look at your no-shows, your late cancellations and the slots you never filled. Our guide to why clinics lose patients goes through them.

VAT: the point that changes your sums

HMRC's Notice 701/57 exempts services from VAT when two tests are met. The person must be on the right statutory register and working within that profession, and the main purpose must be to protect, maintain or restore the patient's health. So there's usually no VAT on your fees.

Three things follow:

• Exempt income doesn't count towards the £90,000 VAT threshold. You don't have to register if you only sell exempt services.
• You generally can't reclaim VAT on your costs. Budget for rent, software and equipment at the VAT-inclusive price. That's my understanding of the normal rule, so confirm it with your accountant.
• Not everything's exempt. HMRC lists medico-legal reports and reports written solely so a third party can make a decision as taxable. Pre-employment medicals are taxable too.

Watch the edges. Sports massage from someone who isn't registered, Pilates classes open to anyone and retail products may be treated differently, depending on who delivers them and why. That's my caution, as I didn't confirm how HMRC treats each one. The notice does deal with unregistered staff, in section 5, under supervision conditions. If those sales are growing, ask your accountant before you cross £90,000 of taxable sales. This is general information, not tax advice.

Blocks, plans and memberships

Selling six sessions at a discount can help a patient commit. It can also go wrong.

Here's my opinion. Don't sell any block until you've assessed the person and you honestly expect them to need it. Refund unused sessions pro rata, and put that in writing. A patient who got better after three visits is a good result, not a loss.

The GCC's 2026 subluxation guidance says advertising mustn't exploit a patient's vulnerability or limited health knowledge. Long prepaid care plans sold on fear are the thing I'd stay well away from.

The 1 January 2027 change

The subscription rules in the Digital Markets, Competition and Consumers Act 2024 are close. Draft regulations were laid in October 2026, and they're due to apply to contracts made on or after 1 January 2027, if Parliament approves them. Law firm summaries describe rolling, auto-renewing and trial contracts as the target. They point to two 14-day cooling-off periods, reminder notices on a durable medium, easy cancellation and refunds within 14 days.

If you sell a monthly maintenance plan by direct debit, assume this could apply to you and ask your adviser now. I couldn't confirm how the final rules treat clinic plans, and the summaries I read don't mention a health exclusion.

Bought online or by phone

The Consumer Contracts Regulations 2013 have no exclusion for health services, as I read regulation 6. So a block bought online or by phone is likely to carry a 14-day right to cancel. If the first session falls inside those 14 days, get the patient's express request to start, and tell them they'd pay for what they've used. That's my reading, so check it with your adviser.

Late cancellation and no-show fees

I think these are fair if they're clear. Two tests:

• Tell people before they book, and again in the confirmation text.
• Keep it tied to what you lose. Under section 62 of the Consumer Rights Act 2015, an unfair term isn't binding on a consumer. A charge linked to the slot you lost looks easier to defend than a charge for a whole block. That's my view, not a ruling, so take advice on your wording.

Use judgement. A patient who was too unwell to come, or who's been sent to A&E, shouldn't get a bill from you. I'd waive the first one for anybody, because the goodwill is worth more than £51.

Insured patients are different. Bupa's network says recognised practices invoice Bupa online and don't invoice its customers directly, so check your agreement before you charge anyone anything. I couldn't confirm what each insurer says about missed appointments.

Insurers and your fee

Insurer work sits at an agreed rate, not your rate. Bupa says its recognised practices get agreed fees, and it doesn't list them on the page I read. So work out your margin at that rate separately. Your own patients shouldn't quietly subsidise it, or the other way round.

Raising your fees

• Review them once a year, on a set date.
• Tell patients in the middle of a plan that their current fee holds until it ends.
• Change the website and the booking system on the same day.
• Tell insurers and referrers if your agreement says so.

David Bell, founder of Real Business Systems

David helps small UK businesses get found, answer every enquiry and keep customers coming back. We sell some of the services mentioned here, and we say so where they come up.