The Medical Director Agreement for a Texas Med Spa

What the document must establish, which clauses Texas names in writing, and the terms owners discover too late.

What the agreement is actually for

Most owners come to the medical director agreement expecting a formality. It is closer to the operating manual for the clinical side of the business. It answers, on a specific date and in writing, who authorized each procedure on your menu, which providers may perform it, what happens when a patient reacts badly, and who picks up the phone when the named physician does not.

That matters because the underlying activity is regulated as medicine. The Texas Medical Board states that nonsurgical medical cosmetic procedures, including the injection of medication or substances for cosmetic purposes and the use of a prescription medical device for cosmetic purposes, have been determined by the TMB to be the practice of medicine. Once that is true, the agreement is not describing a vendor relationship. It is describing how medicine is delegated inside your business.

Where Texas sets the floor

Two agencies shape the document, from different directions.

The Medical Board governs the delegation itself. Its published guidance is that a physician, PA or APRN must either be onsite during the procedure or be immediately available for emergency consultation in the event of an adverse outcome, and that if necessary, the physician must be able to conduct an emergency appointment with the patient. That is a standard about reachability and follow-through, and your agreement has to be able to deliver it during the hours you actually open.

The Department of Licensing and Regulation governs the facility side where lasers are involved, and it is far more prescriptive about the paperwork. If your practice holds a laser hair removal facility registration, TDLR is explicit that the agreement must be in the form of a written contract, and it names what that contract has to contain. Those requirements are covered in more depth on our page on Texas laser hair removal requirements.

Practices that do no laser work still need the delegation right but lose TDLR’s checklist, which remains a good template even where it does not strictly apply.

The clauses TDLR names in writing

For a registered laser hair removal facility, TDLR states that the written contract with the consulting physician must contain at a minimum four things. They are worth reading as a list of questions your agreement should be able to answer.

The first is proper protocols for the services provided by the consulting physician at the facility. Protocols are referenced by the contract but live alongside it, and they move when the menu moves.

The second is a provision for the consulting physician to audit the facility’s protocols and operations. This is an audit right, and it is the clause owners most often strike out because it feels intrusive. Removing it does not make the practice safer; it removes the mechanism by which the physician can see what is happening under their delegation.

The third is a commitment that the consulting physician will be available for emergency consultation with the facility as appropriate to the circumstances, including, if the physician considers it necessary, an emergency appointment with the client.

The fourth is a alternate consulting physician who will be available for consultation with the facility, if the consulting physician is unavailable.

The availability clause is the one that gets tested

Every other clause is read on a calm day. This one is read on the worst day the practice has had.

An availability term that says the physician is “available as needed” says nothing a reader can check afterwards. A usable one names the hours during which the practice treats patients, states the contact route and the expected response window, and identifies who answers when the primary does not. If your practice runs evening and weekend appointments, the clause has to reach those hours, because that is when a thin arrangement fails.

Distance is a separate question from reachability, and Texas treats it separately. For laser hair removal facilities, TDLR states that the primary practice site of the consulting physician must be located within 75 miles of the laser hair removal facility. That is a geographic constraint on the contract, and it is one of the few hard numbers in this area. It also has consequences for multi-site operators, which we cover on our locations page.

Remote arrangements are permitted and common, but permitted is not the same as unreachable; see remote medical directors in Texas.

The alternate physician is a requirement, not a courtesy

Owners routinely treat the backup physician as a box to fill in later. TDLR treats it as structural.

The department states that a facility must designate another physician to serve as a backup in the event that the facility loses the services of the consulting physician, that the consulting physician and alternate consulting physician cannot be the same person, and that the primary practice site of the alternate consulting physician must be located within 75 miles of the laser hair removal facility.

Read together, those three sentences rule out the arrangement many practices actually have, which is a single physician with an informal understanding that a colleague will help out if needed. The alternate has to be designated in the contract, has to be a different person, and has to be geographically close enough to be real.

There is also a consequence written into the same guidance. TDLR states that if a facility loses the services of the consulting physician(s), then the facility must immediately cease all laser hair removal procedures. That is the sentence that turns a naming exercise into a continuity plan.

Scope: which providers, which procedures

The most common defect is not a missing clause. It is that the agreement describes a smaller business than the one now operating.

An agreement signed when the practice offered neurotoxin and filler does not automatically extend to the microneedling device bought eight months later, the weight-management program added after that, or the nurse practitioner hired in the spring. Delegation is specific to what each provider is authorized to do, which is why a shared template signed by differing provider teams is not the same as an agreement that fits.

Tie the agreement to a dated schedule of procedures and providers rather than burying the list in prose, so it can be revised without reopening the whole document, and make updating that schedule the second step of adding any service. The mechanics underneath are covered in delegation and standing orders.

Records, audit rights and where the contract lives

A contract nobody can produce is a contract nobody signed.

TDLR is direct about this for laser facilities: the agreement must be current, maintained at the facility, and made available to the department upon request. Three separate obligations sit inside that sentence. Current rules out the version that lapsed at renewal. Maintained at the facility rules out the copy that only exists in the owner’s email. Available on request rules out the one nobody at the front desk can find.

The audit provision is the other half. If the physician has a contractual right to review protocols and operations, someone has to schedule that review and record that it happened. An audit right that is never exercised is evidence of the opposite of what the clause was for.

The clinical evaluation that precedes treatment is a separate requirement, covered under good faith exams in Texas.

Termination, and what the agreement cannot fix

Termination clauses in these agreements are often copied from commercial templates, which is where the notice period comes from. A thirty-day notice term is unremarkable in a supply contract. In an oversight agreement it defines how long you have to find a replacement before the clinical basis for treating disappears.

Work backwards from that. If you cannot realistically identify, vet and contract a replacement inside the notice window, the window is wrong. The sequencing overlaps with what an engagement includes.

Finally, the limits. A well-drafted agreement does not resolve an ownership structure that does not work, which is a separate question addressed under MSO and PC structure. It does not extend a provider’s license beyond its scope. It does not substitute for the protocols it references. And it is designed to support a defensible oversight arrangement rather than to certify one; the review that establishes whether your specific arrangement holds up belongs with Texas healthcare counsel.

This article is general information for Texas practice owners and is not legal advice. It is designed to support planning conversations, not to replace them. Rules change; review your own arrangement with Texas healthcare counsel before acting. Last reviewed August 2026.