Before You Sign a Medical Clinic Lease: 10 Questions to Ask About the Space

A space can look perfect on a tour and still be the wrong place to build a clinic.

Location, size and visibility matter. But some of the biggest construction surprises sit in the base building: what is under the floor, where the services run, what can be cored, and which upgrades the landlord will allow.

Before you commit to a lease for a family practice, walk-in clinic or other healthcare space in Ontario, ask these 10 questions.

1. Does zoning permit the clinic you want to operate?

Confirm the intended use with the municipality, not just the listing or the landlord. A space advertised as “medical” may still need review for your particular mix of services, especially if you plan to add imaging, procedures, a pharmacy or other uses.

Zoning and building permits are separate questions. In Toronto, for example, a building permit application isn’t complete without a Zoning Applicable Law Certificate.

2. Will a change of use or renovation trigger permits and upgrades?

Turning a former retail or office unit into a clinic can involve more than a standard interior fit-out. The proposed use, the building’s existing classification and the extent of the work can all affect permits, fire protection, accessibility and other code requirements.

Ontario’s Building Code addresses both changes of use and renovations, but the exact obligations depend on the project. Get an early code review before you commit to a construction budget or an opening date.

3. What is directly beneath your unit?

Is the floor slab-on-grade, over underground parking, or above another occupied suite? The answer can change your whole plumbing strategy.

On a slab-on-grade, new drainage may mean trenching and reinstating the concrete. On an upper floor, you may need approved slab penetrations, access to the ceiling below, or a different pipe route altogether.

This matters because Public Health Ontario’s clinical office guidance recommends a hand washing sink wherever treatment, procedures or physical exams take place. Make sure the floor plan can actually support the plumbing.

4. Are there no-core zones or limits on slab penetrations?

Never assume a contractor can simply drill through the floor. Multi-storey buildings may have post-tensioned concrete, structural beams, embedded services, waterproofing or designated no-core zones.

The landlord may require slab scanning or X-rays, review by the base-building structural engineer, written approval and access to the space below. Even an approved opening may need firestopping, waterproofing and after-hours coordination. Find out before you place the exam rooms and sinks.

5. Is the HVAC system suitable for a clinic?

Ask what the existing rooftop units or base-building air system can actually supply. A clinic has different heating, cooling, fresh air and room control needs than many previous tenants.

Think about the waiting area, exam rooms, occupancy, operating hours, any procedure rooms and future expansion. A mechanical engineer should assess capacity, ventilation, zoning, ductwork and any changes needed. The question isn’t whether air comes out of the diffusers. It’s whether the system works for your layout and services.

6. Is the building sprinklered, and how will fire alarm work be handled?

Confirm whether the building has sprinklers and a fire alarm system, which areas they serve, and whether your fit-out affects sprinkler heads, detectors, fire separations or other life safety components.

The need for new or upgraded systems depends on the building and the work. An older, unsprinklered property doesn’t automatically need a full retrofit just because a clinic is moving in. Also ask whether the landlord requires its own designated contractors for sprinkler and fire alarm changes, testing or tie-ins. That can have a real effect on your schedule.

7. Is there enough electrical capacity, with room to grow?

Check the electrical service, panel capacity, available circuits and routes for new cabling. A basic clinic may fit the existing supply, while imaging, larger equipment or a future expansion may not.

If upgrades are needed, confirm whether the building can take them, how approvals will work, and who is responsible for new distribution, metering or base-building changes. Where equipment loads or building limits are uncertain, have an electrical engineer review them.

8. Will accessibility and exit requirements work for the layout?

Look beyond the suite entrance. Consider barrier-free access from the street or parking, corridor and door clearances, washrooms, changes in level, elevators where relevant, and safe exits.

Requirements depend on the existing building and the scope of work, and not every minor renovation triggers the same upgrades. Some improvements may fall in common areas the landlord controls. Confirm both feasibility and responsibility before you make assumptions.

9. Can the landlord provide reliable base-building drawings?

Ask for the latest architectural, structural, mechanical, electrical, plumbing, sprinkler and fire alarm drawings, along with any tenant construction manual. Your architect and engineers will likely need them to understand existing systems, coordinate new connections and prepare the permit package.

As-built drawings can be out of date, so site verification still matters. If records are missing, allow time for investigation rather than designing from guesswork.

10. Who approves the work, who is responsible, and when does the lease clock start?

Get the answers in writing. Clarify who is responsible for HVAC upgrades, slab coring, plumbing connections, base-building fire protection, accessibility improvements, engineering reviews and contractor charges. Ask about landlord design approvals, mandatory vendors, insurance, after-hours work, shutdowns and access to other units.

A due diligence period and conditions tied to zoning, construction feasibility and approvals are worth discussing. Your fixturing period and lease start should reflect a realistic permit and construction plan. Have your own lawyer review the terms.

The best next step: a pre-lease walkthrough

Before you sign, bring in someone who understands clinic design and construction. Get the base-building drawings and construction rules, walk the space, and have the right professionals look at the major risks before the layout and lease terms are final.

A great address isn’t enough. You need a space you can actually build, permit and run as a clinic without avoidable surprises.

Planning a new clinic or moving an existing one? We’ve helped with site selection, feasibility, planning and construction for more than 20 clinics. Email info@medpros.ca to talk through a space before you commit.

Want our monthly MedPros Insider newsletter, or first word on new clinic, location and pharmacy opportunities? Email info@medpros.ca.

Sources

• City of Toronto: Building Permit Review Streams (Zoning Applicable Law Certificate)
• Ontario Building Code, O. Reg. 163/24 (change of use and renovation)
• Building Code Act, 1992
• Government of Ontario: How to make public spaces accessible
• Public Health Ontario: Infection Prevention and Control for Clinical Office Practice (hand washing sinks)

This is general information, not legal or building code advice for a specific property.