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Don’t get screwed.</text><text x="58" y="258" font-family="Arial,Helvetica,sans-serif" font-size="30" font-weight="600" fill="#6b5b4d">Leases, TI, NNN &amp; buildouts — negotiated in your favor</text><g transform="translate(1010,86)" fill="none" stroke="#C0531F" stroke-width="9" stroke-linejoin="round"><rect x="20" y="40" width="150" height="130"/><line x1="20" y1="40" x2="95" y2="6"/><line x1="170" y1="40" x2="95" y2="6"/><rect x="50" y="80" width="36" height="36"/><rect x="104" y="80" width="36" height="36"/><rect x="74" y="128" width="42" height="42"/></g></svg>

How Do I Negotiate a Lease and Buildout for an Urgent Care?

Direct Answer

An urgent care is a medical buildout wearing a retail address, and the cost gap between the two is enormous: generic retail fit-out is $75–$150 per square foot, but a licensed urgent care runs $150–$350 per square foot all-in because of medical gas, lead-lined X-ray walls, exam-room plumbing, ADA-grade everything, and code-driven HVAC.

A typical 3,000–5,000 sq ft clinic lands at $500,000–$1.5M in construction alone. The single biggest money move: make the landlord fund the medical-grade work through a large tenant improvement allowance ($50–$100+ per square foot) and free rent during a long buildout period, because urgent-care construction takes 4–8 months and you cannot generate revenue without state licensure and the certificate of occupancy.

The line items that ambush first-timers are the X-ray room lead shielding (lead-lined drywall, doors, and view windows certified by a physicist — $15,000–$40,000+), medical gas/vacuum if you offer it, dedicated exam-room sinks and plumbing (12–15 ft of plumbing per exam room), and HVAC with higher air-change rates for clinical spaces.

Negotiate a lease that recognizes the specialized, hard-to-relet improvements you're paying for — push for a longer term (7–10 years) in exchange for higher TI, an early-termination right if you can't get licensed, exclusivity against competing clinics in the center, and a struck or capped restoration clause so you don't pay to demolish a lead-lined room you built.

Why Medical Buildout Costs 2–3x Retail

The premium is structural and regulatory, not cosmetic:

• Lead shielding for radiology: an X-ray room needs lead-lined gypsum board, lead-glass view windows, and shielded doors, with a shielding plan stamped by a medical physicist and inspected. Budget $15,000–$40,000+.
• Exam-room plumbing: every exam and procedure room needs a hand sink with hot water; figure $2,000–$5,000 per room in plumbing once you account for runs and ADA fixtures.
• Medical gas/vacuum (if applicable): oxygen and vacuum piping is specialized, certified work — $10,000–$30,000+.
• HVAC for clinical air quality: higher air changes per hour, controlled humidity, and sometimes isolation for a sick-patient room push HVAC well above retail.
• ADA and life-safety: wider corridors, accessible restrooms, panic hardware, and emergency power add cost retail buildouts skip.

The Lease Math — Trade Term For TI

Because your improvements are expensive and specialized (hard for the landlord to relet), you have a real negotiating chip: offer a longer term and stronger credit in exchange for the landlord financing the medical work.

• TI allowance: push for $50–$100+ per square foot. On 4,000 sq ft that's $200,000–$400,000 the landlord contributes.
• Free rent / abatement: medical buildouts take 4–8 months; demand rent abatement through construction plus a ramp so you're not paying rent on an unlicensed, empty clinic.
• Term: 7–10 years with renewal options justifies higher TI and protects your sunk capital.
• Licensing contingency: add a right to terminate or delay if state licensure or the certificate of need (in CON states) is denied — don't get locked into rent you can't legally use.

Where The Money Hides — Don't Get Surprised

• Parking ratios. Medical uses require 4–5 parking spaces per 1,000 sq ft, far more than retail. A site short on parking can be denied a permit — verify before signing.
• Power and generator. Clinics often need emergency/standby power for critical circuits; a generator and transfer switch add $20,000–$60,000.
• Specialized GC. Hire a contractor with healthcare buildout experience — a retail GC will under-bid the medical scope and bury you in change orders.
• Long lead times. Medical equipment, lead-lined doors, and specialty HVAC have long lead times; order early or your CO slips and rent accrues.

How Not To Get Screwed By The Landlord

Medical tenants pay the most and must protect the most:

• TI clawback / amortization. Landlords love to "give" TI then amortize it into rent at 8–12%. Insist on a true contribution; if amortized, negotiate the rate and term hard.
• Rent starting before the CO. Never let rent commence on lease execution or delivery — tie rent commencement to the certificate of occupancy or licensure, not to a calendar date that ignores construction reality.
• The restoration clause. A clause forcing you to remove lead shielding, med gas, and exam plumbing at lease-end can cost $50,000–$150,000. Strike it, cap it, or limit it to non-fixed equipment.
• No exclusivity. Without exclusivity, the landlord can lease the next unit to a competing urgent care or a clinic. Demand a medical-use exclusivity clause in your trade area within the property.
• Base-building vs TI shell game. Get a written base-building definition so the landlord — not your TI budget — carries roof, structure, core HVAC, and code-mandated upgrades triggered by your work.

A Quick Negotiation Framework

1. Confirm zoning, parking ratio, and CON/licensure path before the LOI.
2. Trade a 7–10 year term for $50–$100+/sf TI and rent abatement through buildout.
3. Tie rent commencement to the CO, not the calendar.
4. Hire a healthcare-experienced GC and MEP engineer for shielding, med gas, and HVAC.
5. Strike the restoration clause and lock medical-use exclusivity.

FAQ

How much does it cost to build out an urgent care? Expect $150–$350 per square foot all-in — roughly 2–3x a generic retail fit-out — so a typical 3,000–5,000 sq ft clinic runs $500,000–$1.5M in construction. The premium comes from lead-lined X-ray rooms, exam-room plumbing, clinical-grade HVAC, ADA work, and potentially medical gas and standby power.

How much TI allowance should I ask for? Push for $50–$100+ per square foot plus rent abatement through the 4–8 month construction period. Because your improvements are specialized and hard for a landlord to relet, you can credibly trade a 7–10 year term and renewal options for the landlord funding the medical-grade scope.

Why does the X-ray room cost so much? Radiology requires lead-lined gypsum board, lead-glass view windows, and shielded doors, plus a shielding plan stamped by a medical physicist and an inspection. That package commonly runs $15,000–$40,000+, and skipping or under-building it will fail inspection and delay your certificate of occupancy.

When should rent start? Tie rent commencement to the certificate of occupancy or state licensure, never to lease signing or delivery of the shell. Medical buildouts take months and you cannot legally see patients without licensure, so paying rent on an unlicensed, empty clinic is pure cash burn you should negotiate away.

What lease protections matter most for a clinic? A licensing termination right (in case approval is denied), a struck or capped restoration clause (lead shielding and med gas are costly to remove), medical-use exclusivity in the property, and a written base-building definition putting structure, roof, and code-triggered upgrades on the landlord rather than your TI budget.

Sources

• CBRE — Healthcare Real Estate and medical office construction cost reports.
• JLL — Healthcare / Life Sciences fit-out and Tenant Improvement guides.
• Cushman & Wakefield — Healthcare Real Estate advisory and medical leasing briefs.
• RSMeans (Gordian) — medical and commercial construction unit cost data.
• Urgent Care Association (UCA) — clinic development and operations benchmarks.
• U.S. NRC / state radiation control programs — X-ray shielding and physicist plan requirements.
• ASHRAE Standard 170 — ventilation of health care facilities (air-change requirements).
• BOMA International — base-building delivery and CAM standards.