Managing quarterly taxes in your therapy practice can feel like juggling too many things at once…

Clinical hours, client care, business finances, and staying on top of IRS rules.

For most therapists and mental health professionals, this part of running a business isn’t the most exciting, but it’s critical for avoiding penalties, protecting your cash flow, and keeping tax season manageable.

If you’ve ever felt unsure about how much to send in a quarterly payment, or whether the deadlines for therapists apply to you, this guide’s for you.

We’ll break down quarterly taxes step-by-step so you can plan ahead, keep your monthly income organized, and work with a tax advisor when you need expert tax advice.

Why Quarterly Taxes Matter for Therapists

When you’re self-employed (in a full therapy practice or running a side), you don’t get paychecks with taxes already withheld.

The IRS expects you to pay federal taxes on your taxable income throughout the year, not just at tax season. That means making a quarterly payment based on your projected earnings.

Failing to send enough can lead to:

• Interest charges from the tax authority
• Penalties for underpayment
• A large, unexpected bill when filing your tax return

Therapists often underestimate their income month to month, especially if they’re building a waitlist or opening more treatment spots.

That’s why quarterly taxes are less about guessing and more about using accurate profit and loss statements, a financial projection, and respect to matters referenced in IRS guidance.

Who Needs to Pay Quarterly Taxes (and Who Doesn’t)

Not every therapist is required to send quarterly payments. The main determining factor is your taxable income level and whether you expect to owe at least $1,000 in federal taxes after subtracting credits and withholdings.

You likely need to pay quarterly taxes if:

• You are a self-employed person with earnings from a therapy practice or life coaching business.
• Your monthly income adds up to more than the safe harbor rule allows without prepayment.
• You have business assets generating profit and additional tax obligations.

You might not need to pay if:

• You work for an employer who withholds enough from your paychecks.
• Your income is low enough that no tax liability will be due.
• You qualify for certain exceptions outlined in IRS provisions for individuals.

Don’t forget: some states require state-level quarterly tax payments in addition to federal taxes.

Quarterly Tax Deadlines for Therapists

The IRS sets four main quarterly tax deadlines each year, and missing them can trigger penalties.

Quarter	Covers Income Earned	Payment Due Date
1st Quarter	January 1 – March 31	April 15
2nd Quarter	April 1 – May 31	June 15
3rd Quarter	June 1 – August 31	September 15
4th Quarter	September 1 – December 31	January 15 (next year)

If the date falls on a weekend or holiday, the tax authority pushes it to the next business day.

To keep on track, create a tax calendar and set reminders for each quarterly tax deadline. Many therapists set aside cash from each income month into a separate savings account so the money is ready when deadlines arrive.

How to Figure Out What to Pay

Estimating quarterly income accurately is key to avoiding penalties and overpayments.

You can calculate your quarterly payment using:

• Last year’s tax return as a baseline
• Current business finances including profit and loss statements
• A financial projection based on your expected clinical hours per week and hourly rate

Some therapists use the IRS Estimated Tax Worksheet, while others prefer to work directly with a tax advisor who specializes in mental health professionals.

An accountant can account for month-to-month fluctuations, degree of accuracy in income reporting, and provisions for individuals under the safe harbor rule.

If you’ve had major changes like fewer treatment spots, an expanded life coaching business, or added exclusive add-ons, those should be factored into your quarterly payment calculations.

How to Pay Quarterly Taxes

The IRS and state tax authority offer multiple payment methods. Each has its own level of convenience and processing fees.

• Bank transfer – Pay directly from your bank account using IRS Direct Pay or EFTPS. No processing fees and immediate confirmation.
• Credit card – Useful for short-term cash flow, but watch for processing fees.
• Check or money order – Mailed with the correct IRS form, but slower and riskier if close to the deadline.

Some therapists prefer credit card payments for the points or rewards, but be cautious about relying on this method if your business finances are tight.

A good practice is to schedule the payment right after reviewing your monthly income, so you don’t risk spending what you’ve set aside for taxes.

Tips for Staying Organized All Year

Quarterly taxes get much easier when you have a simple, month-to-month organization system.

Therapists who wait until tax season to get their numbers together often face the highest stress – and higher accountant fees.

Here are some ways to stay on top of it:

• Create a separate savings account for tax funds.
• Set aside a fixed percentage of each client payment for taxes before using the money for business or personal expenses.
• Track deductions like office rent, continuing education, professional memberships, and business assets.
• Review your loss statements monthly to catch changes in cash flow early.

Some tax advisors also suggest using payroll software if you pay yourself a regular amount, even as a self-employed person.

This can make quarterly payment planning easier and keep your business finances cleaner for your tax return.

Common Mistakes Therapists Make with Quarterly Taxes

Even experienced therapists can run into trouble with quarterly taxes. Some of the most common pitfalls include:

• Underestimating quarterly income – This can happen when clinical hours vary or new clients start mid-year.
• Missing state-level quarterly tax payments – Each state has its own laws and deadlines for therapists.
• Ignoring additional tax obligations – If you have income from writing, speaking, or a life coaching business, those earnings must be included.
• Failing to apply the safe harbor rule – This can help avoid penalties if your earnings spike unexpectedly.

A tax advisor can help you avoid these risks by checking your taxable income regularly and making adjustments as needed.

Why Working with an Accountant Makes a Difference

While it’s possible to handle quarterly taxes on your own, working with a qualified accountant or tax advisor can save you time, stress, and money. They’ll know how to:

• Apply IRS provisions for individuals and therapists specifically
• Track quarterly tax deadlines and state-level quarterly tax payments
• Factor in business assets, loss statements, and financial projection accuracy
• Spot deduction opportunities you might miss on your own

The biggest advantage is reducing the chance of penalties and making sure you’re paying the correct amounts.

That means you can focus on your therapy practice, treatment spots, and waitlist instead of worrying about tax season surprises.

For some therapists, the lowest prices for accounting services aren’t the priority.

The real value is in having a professional who understands the distinction between therapy income and other earnings, and can work with respect to matters referenced in tax laws.

With the right organization, clear step instructions, and a trusted tax advisor, you can meet every quarterly payment deadline with confidence and keep your therapy practice thriving month to month.

If you’d rather spend your clinical hours with clients instead of wrestling with forms, payment amounts, and quarterly tax deadlines, our team can help.See our full accounting services for therapists here. We’ll keep your business finances in order so you can focus on the work that matters most.