A med spa's cash moves on a different calendar from its profit. Patients pay for packages before the treatments are delivered, the practice pays for neurotoxin before it is injected, payroll with commissions lands twice a month, device loans draft on fixed dates and quarterly estimated taxes arrive whether or not December was slow. The P&L averages all of that into a monthly number; the bank account does not. This page is about seeing the next thirteen weeks before they happen, paying bills with a record and a control, and keeping the numbers a lender will ask for ready.
The 13-week forecast, built from your calendar
The forecast is weekly because a med spa's commitments are weekly: payroll on the 5th and the 20th, the injectables order every other week, rent on the first, the device loan on the 15th. Collections come from the POS, net of merchant fees and split between treatments, retail and new package sales; membership billing is its own line because it arrives in one block on its billing date. Each week we roll the forecast forward, replace the forecast with actuals for the week just closed and show the variance, so the model gets better instead of staler. A cash floor, the balance below which you do not want to go, sits under the closing cash line, and any week that breaks it gets flagged with the decision that fixes it.
| Illustrative two-location practice (round numbers) | Week 1 | Week 2 | Week 3 | Week 4 |
|---|---|---|---|---|
| Opening cash | $60,000 | $52,000 | $76,000 | $39,000 |
| POS collections, net of merchant fees | $46,000 | $44,000 | $48,000 | $45,000 |
| Membership billing | $24,000 | — | — | — |
| Payroll and payroll taxes | ($38,000) | — | ($38,000) | — |
| Injectables and supplies | ($22,000) | — | ($22,000) | — |
| Rent, device loans, other operating | ($18,000) | ($20,000) | — | ($12,000) |
| Estimated taxes and owner distribution | — | — | ($25,000) | ($20,000) |
| Closing cash (floor $50,000) | $52,000 | $76,000 | $39,000 | $52,000 |
In the illustration, week three breaks the $50,000 floor because payroll, an injectables order and a quarterly estimated tax payment land in the same week. Seen three weeks out, the fix is ordinary: move the injectables order to week four, or hold the week-four distribution until after the next membership billing. Seen on the morning the payroll drafts, the fix is a line of credit draw or a late vendor. The forecast exists to turn the second situation into the first, and weeks five through thirteen carry the same lines, including the next estimated tax date and any device payment coming due.
Bill pay: we queue, you approve, you release
Bill pay in a med spa should be designed around one fact: the owner is the only person who should be able to move money. Vendor invoices come into a dedicated inbox, we enter them in QuickBooks Online coded to the aesthetics chart of accounts and to the right location and entity, set the due date and put them in the queue. You see the queue, approve what is paid and release each payment from your own bank or bill pay tool. Balance Partners never holds signing authority, bank credentials or the ability to initiate an ACH, wire or check. The result is an approval record for every payment, a payables aging you can trust and no bills paid twice because a card statement and an invoice both looked unpaid.
Vendors and 1099s, tracked from the first payment
The medical director, the marketing agency, the laser service technician, the cleaning company and the contractor who built out the second room all have to be sorted by January. We collect a Form W-9 before a vendor is paid and track payments by method all year, because the rules differ: for 2026 payments, Form 1099-NEC is required at $2,000 or more and is due by February 1, 2027; payments made by card are reported by the processor on Form 1099-K rather than by you; and medical and health care payments, including a medical director's fee, go on Form 1099-MISC box 6, where the corporate exemption does not apply, so a fee paid to a professional corporation is still reported.
MSO and professional entity: settling the fee on purpose
Where state corporate-practice-of-medicine rules mean the practice runs a management services organization alongside a professional entity, cash crosses between the two every month and that crossing has to match the management services agreement. We invoice the management fee from the MSO as the agreement describes, allocate shared payroll and costs, settle on a scheduled date and reconcile Due to and Due from to zero afterward, then forecast both entities so the professional entity has the cash to pay the fee when it is due. Whether you need the structure is a question for a health-care attorney in your state; our job is the books and the cash once it exists. Our guide on MSO and PC structure accounting covers the entries.
Financing-ready reporting and membership forecasting
An equipment lender, an SBA lender or a landlord typically asks for an interim P&L and balance sheet, a debt schedule, the last two or three years of returns and a projection. From closed books that package is a refresh, not a project, and the 13-week forecast is the projection. Membership revenue gets the same treatment: active members, pauses and cancellations from the POS become next month's billing line and a churn figure you can act on. For the thinking behind this work, see a 13-week cash flow forecast for a med spa and why your med spa shows a profit but has no cash.