Opening a clinic or aesthetic centre: the health operating authorisation

Every health centre, service or establishment needs it before starting its activity. The state framework is Real Decreto 1277/2003, which classifies centres (annex I) and defines the healthcare offer by coded units (annex II). This includes medical clinics and practices, dental clinics, physiotherapy, health psychology, medical examination centres and aesthetic medicine centres, among others.

The healthcare offer is declared unit by unit. Aesthetic medicine is unit U.48: a healthcare unit where a doctor is responsible for non-surgical treatments aimed at aesthetic improvement. Aesthetic surgery is U.47 and, since Orden SND/1002/2024, it is reserved for doctors specialising in Plastic, Aesthetic and Reconstructive Surgery or another surgical or medical-surgical specialty with those competencies in their training programme. Your authorisation only covers the units you declare and are granted: you cannot advertise or provide anything outside of them.

The authorisation is granted by the Department of Health of your autonomous region and is independent of the municipal opening licence: you need both. Once authorised, the centre must display the official badge in a visible place and state its registration number in all its advertising (article 6 of Real Decreto 1277/2003).

The installation authorisation is requested before starting the building works, and only when the centre is newly created or requires a substantial alteration of the structure or facilities. The Health Department reviews the project and the plans on paper. A dental practice or clinic set up in an already suitable premises, without substantial building works or fixed electromedical equipment, can usually go straight to the operating authorisation.

The operating authorisation is the one that allows you to open: it is requested with the finished centre and usually includes an inspection visit that checks the actual facilities, equipment and staff. In the Community of Madrid, administrative silence for this procedure is negative, so you cannot open without an express resolution.

Afterwards, there is the modification authorisation (changes in healthcare offer, structure or ownership) and the periodic renewal: the authorisation expires and must be renewed within the period set by each region. In Madrid, the validity is 8 years (4 for assisted human reproduction) and the renewal is requested at least 3 months in advance; if it is not requested, the authorisation loses its validity and you have to start from scratch.

The material requirements depend on the units you declare: reception and waiting areas, consultation rooms with an examination area and sink, toilets, cleaning and sterilisation conditions, and the specific equipment for each unit (for example, laser or radiodiagnostic equipment, which carries additional radiological protection requirements). Each region details them in its regulations: in Madrid, Orden 1158/2018 sets the general technical requirements for centres without hospitalisation.

Every centre designates a responsible person or technical health director with an official qualification appropriate to the healthcare offer. In a U.48 aesthetic medicine unit, the responsible person is a doctor; in a dental clinic, a dentist. From 1 July 2026, the new article 7 of Real Decreto 1277/2003 (introduced by Real Decreto 239/2026) also requires keeping an updated file of all healthcare staff, with their qualifications and specialties, and informing new professionals of the centre's safe practices.

Essential additions that the inspection reviews: a professional civil liability policy covering the healthcare activity and a contract with an authorised biohazardous waste manager for needles and sharps. Managora reviews qualifications, drafts the report and leaves the file ready for inspection.

Real Decreto 1277/2003 is only the common basis: the procedure, forms, tasas (official fees) and renewal are regulated by each autonomous region, and the differences are significant. Madrid articulates the procedure with Decreto 51/2006 (modified by Decreto 205/2023) and charges the tasa according to the type of centre; Andalusia does it with Decreto 69/2008 and a tasa per healthcare unit updated every year in its Budget Law; Catalonia applies Decret 151/2017.

In Madrid, furthermore, certain practices without fixed electromedical equipment renew through a simplified responsible declaration instead of repeating the entire authorisation. In Andalusia, there is an ongoing public consultation for a new decree that will introduce a responsible declaration and communication in some cases.

The official tasa is set by each region and increases with the number of healthcare units in the centre. You can see the updated amount of our fees on the procedure's page; we will confirm the regional tasa in writing as soon as we know your region and healthcare offer, and we will pay it on your behalf as a suplido (out-of-pocket expense).

Tattooing, micropigmentation and piercing are not healthcare activities under Real Decreto 1277/2003: each region regulates them with its own hygienic-sanitary regulations, and the regime changes a lot. In the Community of Madrid, Decreto 35/2005 applies: the establishment must register in the regional registry before opening and meet requirements for structure, hygiene and training of the applying staff. In Andalusia, following Decreto 71/2017 (modified by Decreto 130/2021), there is no longer a health authorisation: a responsible declaration is submitted to the town hall before starting, and the applicators prove their competence through a certificate of professionalism, an academic Vocational Training qualification or accreditation of cumulative partial training.

Be careful with the boundary: if medical procedures are also performed in the studio (medical laser, mesotherapy, micropigmentation for health purposes), that part requires authorisation as a health centre with its corresponding unit. Advertising with health terms without authorisation is prohibited by article 6 of Real Decreto 1277/2003.

Managora prepares and submits it for you from start to finish: we identify the correct healthcare units for your activity, draft the technical-health report, review plans and qualifications, submit the application to the Health Department of your region, pay the tasa as a suplido and accompany you until the resolution and inspection. We also notify you of the renewal so that the authorisation does not expire.

You can see the updated amount on the health operating authorisation procedure page and start today: the sooner the application goes in, the sooner you open your centre with all the guarantees.