The 7 questions Pereff asks before quoting your healthcare TI — and why you should ask them of every GC

Most doctors pick a GC based on who gave the lowest per-square-foot number. These are the seven questions that separate a contractor who will deliver on budget and on schedule from one who won't — and how Pereff answers each one.

Every doctor who has been through a bad construction experience — the wrong number, the change orders, the delays, the contractor who went silent — says the same thing afterward: 'I didn't know the right questions to ask.' The problem is not that doctors are unsophisticated. The problem is that contractors have spent decades refining the sales pitch that hides the answers to the right questions. These are the seven questions that matter — the ones Pereff asks every prospective client before we give a number, and the ones you should ask every contractor before you sign a contract.

1. What type of practice is this, and how many operatories or exam rooms?

This is the first question because it determines the MEP density of the project — the number of plumbing rough-ins, the number of compressed air and vacuum connections, the HVAC zoning requirement. A 4-operatory dental office and an 8-operatory dental office are not scaled versions of the same project. Each operatory adds a dedicated plumbing connection (water supply, vacuum, compressed air drain), and in older spaces, may require saw-cutting the slab to route the rough-in. A contractor who quotes without knowing the operatory count is giving you a number that will move.

2. Does the scope include imaging — and what modality?

A digital radiography (intraoral X-ray) room, a panoramic room, and a cone-beam CT room are three different construction scopes with three different cost implications. Each requires a radiation shielding report from a qualified physicist, city plan review of the shielded room design, and lead-lined wall assembly. A panoramic suite might add $40,000–$60,000 to the project. A cone-beam CT room might add $80,000–$120,000. A contractor who says 'we'll build a room for the X-ray machine' without understanding the shielding requirements has not priced the project — they've priced a room. [DFW cost benchmarks, 2026]

3. Is this a TI in an existing shell, or ground-up? And if TI, what is the slab condition?

In a tenant improvement, the existing slab is the single largest unknown. If the prior tenant poured additional concrete over the original slab, or if plumbing rough-ins were added and encased, or if the slab has existing saw-cuts that are not where you need them — all of these add cost and schedule. A contractor who quotes a dental TI without reviewing the as-built slab condition is making an assumption. That assumption becomes your change order.

For ground-up projects: is the land pad-ready, or does it need site work (grading, detention, utility extension, off-site improvements)? Dr. Sheppard's oral surgery facility in Mansfield — 8,272 SF, $3.1M — required significant off-site infrastructure that the doctor was not aware of when he purchased the land. Pereff identified this in preconstruction and negotiated $200,000 from the City of Mansfield toward those costs. That outcome is only possible if the contractor is also a developer with city relationships. [Pereff project data, Dr. Sheppard Oral Surgery]

4. What is the target open date — and is the schedule driving the budget?

Schedule compression costs money. A dental or medical practice that needs to open by a specific date — a lease expiration, a partnership commitment, a marketing campaign — pays a premium for compressed timelines: premium procurement on long-lead items, overtime for critical-path work, overlapped scopes that require more supervision. A contractor who quotes a low number without understanding your schedule may be quoting a pace that won't meet your date, or may hit your date with unanticipated premium cost.

5. Who will be the superintendent on this project — and how many other projects will they be running simultaneously?

This question reveals the contractor's operational model more clearly than any other. In most commercial construction companies, one superintendent covers multiple active jobs. They rotate through sites on a schedule, meaning your project is supervised for a fraction of the day — and the critical-path work happens without a qualified superintendent present. The result is subcontractor coordination failures, quality defects that are caught later at higher cost, and schedule slippage that compounds. Ask for the name of the superintendent who will be dedicated to your project and ask directly: how many other projects will they be running at the same time?

Pereff's model: every project has one designated full-time superintendent. That superintendent is on site before any subcontractors arrive each day and is the last to leave. They do not split time across multiple jobs. This is not standard practice in the industry — it is a deliberate operational choice that costs more but delivers the quality and schedule performance healthcare clients expect. [Pereff operating principles]

6. Can you produce a loan proforma during the design phase — and will you work with our bank?

A contractor who cannot help you with the financing side of the project is leaving you to figure out one of the most complex parts of a healthcare build on your own. Healthcare construction loans have specific underwriting requirements: the bank wants a realistic project budget, a draw schedule, and in most cases a fixed-price or GMP contract. A design-build contractor who is also a developer — who has 25+ years of relationships with healthcare bank underwriters — can help structure the project in a way that makes the loan approvable and gets you to the draw schedule faster.

7. What is your process for managing change orders — and what causes them?

Change orders are the primary mechanism by which a low bid becomes an expensive project. Ask the contractor to explain exactly what generates change orders on their projects — and what they do to prevent them. In a true design-build delivery, where the architect and the contractor are the same team and the construction documents are co-developed by both, change orders occur only when the city requires something specific, or when the client requests a change mid-construction. That is it. In design-bid-build, change orders occur from scope gaps, design errors, slab conditions, city comments, equipment conflicts, and a dozen other sources that were never in the bid. Ask the contractor to show you their change-order history on the last three healthcare projects.

Pereff's position: 100% on-budget or under-budget on all healthcare projects to date, through true design-build with value engineering. We can show our work. [Pereff operating principles]

The question behind the questions

The purpose of these questions is not to trip up a contractor — it's to assess whether they have built enough healthcare projects to know what they don't know, and to have systems in place to handle what surprises them. A contractor who has built 100 dental and medical offices answers these questions from experience. A contractor who has built 10 — and whose ten projects were all basic TI with no imaging, no medical gas, and no ground-up complexity — answers from theory. The difference shows up in the field, not in the sales conversation.