Medical practices & clinics
Books and taxes for med spas.
Monthly memberships that turn into service credit, prepaid injectable packages, discounted vouchers, and retail skincare. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
April came in at $26,700. A batch of Groupon vouchers got redeemed, so I booked them at what actually landed after Groupon's cut, not the sticker price on the voucher.
- Membership billing batchMembership fees
- Groupon voucher redemptionsVoucher deal revenue
- Allergan injectable orderInjectable product costs
- SkinMedica retail orderRetail skincare inventory
- RN and esthetician payrollClinical wages
Why your books are different
A med spa's books go wrong around memberships, packages, and deal sites.
Almost everything here is paid before, during, or separate from the actual service. A generalist books it all as one revenue stream and you lose sight of what a membership is actually worth or whether that Groupon push paid off.
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1
Membership fees turn into service credit later
A monthly membership fee often converts into credit toward a future facial or laser session, so the cash comes in one month and the service happens in another, sometimes months apart.
What we doKeeps membership fee revenue in its own line and tracks it apart from single-visit sales, so unused credit doesn't get double-counted as new income when it's redeemed. -
2
Groupon and voucher deals pay out less than the sticker price
A $200 laser package sold through a deal site might net you $110 after the site's cut, and if the voucher's face value gets booked as the sale, your real revenue and your real cost per client both read wrong.
What we doBooks what actually lands from a voucher redemption, with the deal site's cut treated as its own cost, so pricing decisions are based on the real number. -
3
Injectable packages get spent before they're delivered
A client who buys a bank of Botox units or a series of laser sessions pays up front, but the treatments happen over months. Booked as one month's income, it hides what is still owed in future visits.
What we doKeeps prepaid package revenue visible as its own line, separate from single visits, so a big package sale does not overstate one month. -
4
Retail skincare sales blend into treatment revenue
A bottle of retinol or a vitamin C serum sold at checkout carries retail margin, not treatment margin, and lumped with service fees it hides which one is actually padding the bottom line.
What we doKeeps retail skincare sales apart from treatment revenue so the real margin on each stays visible.
Your categories
The categories Gus keeps for a med spa.
Set up once for how memberships, packages, and deals all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Membership feesRecurring dues that convert into service credit over time.
- Prepaid treatment packagesInjectable and laser series paid up front, kept apart from single visits.
- Voucher deal revenueWhat actually lands from Groupon or similar deal site redemptions, after their cut.
- Retail skincare salesProduct sold at checkout, kept apart from service revenue.
- Single-visit cash salesFacials, peels, and other services paid at the time of the visit.
Money out
- Injectable product costsBotox, filler, and similar products purchased from the manufacturer.
- Retail skincare inventoryProduct stock from lines such as SkinMedica or SkinCeuticals.
- Clinical wagesRNs, nurse practitioners, and estheticians, kept apart from front desk pay.
- Laser and device leasesEquipment used for cosmetic treatments, logged so they get written off right.
- Deal site and marketing feesWhat Groupon or a similar site keeps, plus general marketing spend.
- Rent and utilitiesTreatment rooms and reception space.
- Malpractice and liability insuranceCoverage for the medical director and clinical staff.
What we watch for you
- Membership credit balance
How much membership revenue is still owed as unused service credit.
- Voucher net rate
What a deal site actually pays out compared to the voucher's sticker price.
- Package revenue owed
How much prepaid package money still represents sessions not yet delivered.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things med spa owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
I book what actually lands after Groupon's cut, not the voucher's sticker price, so the real return on that push is right there instead of buried.
No. I keep membership revenue in its own line, so unused credit doesn't get double-counted as new income the month it's finally redeemed.
Tips still need to run through payroll and get reported, and certain tipped occupations may qualify for a separate deduction on the return. That detail is above my pay grade, so I flagged it for the accountant.
The tax side
The tax side of a med spa.
Most of what matters here is timing membership and package revenue correctly and knowing where the pass-through deduction starts to phase out.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- The pass-through deduction phases outA med spa can lose part or all of the 20 percent pass-through deduction once taxable income passes $201,750 single or $403,500 joint, since aesthetic medical services are a specified service trade.
- Laser and device equipmentLaser and treatment devices can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Injectable and retail inventoryThe cost of injectable products and retail skincare inventory is generally tracked as the cost of what you sell, separate from your other operating expenses.
- Tips for eligible staffStaff who receive tips may qualify for the no tax on tips deduction through 2028, up to $25,000, for occupations on the Treasury list, though tips still owe payroll tax regardless.
Deductions med spas miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Injectable and filler product costs
- Laser equipment maintenance
- Retail product samples
- Malpractice and liability premiums
- Deal site listing fees
- Continuing education for injectors
- License and certification renewal
- Practice management software
- Treatment room supplies
- Marketing and social media costs
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A med spa year, kept every month.
Memberships, packages, and seasonal promotions each run on their own rhythm. Your taxes come on a fixed schedule. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, even with membership credit still outstanding.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether summer promotions or membership growth changed the number.
- October
Before holiday bookings
Gus looks at equipment worth buying and anything worth doing before December, as holiday season bookings for injectables often pick up.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for med spas. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions med spa owners ask first.
Do you handle insurance billing for medical director oversight?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Med spa services are almost always cash-pay anyway, and Gus works from what actually lands in your bank account.
How do you handle a client who never uses up their membership credit?
Gus keeps membership revenue tracked separately from earned service revenue, so unused credit stays visible. What to do about it is a policy call for you and your accountant.
We run seasonal deals through Groupon. Does that skew our numbers?
Not once Gus is keeping the books. He records what actually lands after the deal site's cut, so the real return on a promotion is clear instead of hidden behind the voucher's face value.
Do I owe sales tax on retail skincare products?
Retail products are often subject to state sales tax even though many treatments are not. Gus keeps retail sales in their own line so the accountant can confirm what applies to you.
My RN injector also does some esthetician work. Does that change payroll?
It can, since scope of practice and pay structure can differ by role. That call is above Gus's pay grade, so he flags it and a real accountant looks.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever