From Four Rooms to Four Clinics: How Renee Robles and Christina Ramos Built Five Oaks Speech Therapy
Renee Robles wasn't looking for a business partner. She was getting coffee at Starbucks. Christina Ramos wasn't looking for a career change. She was just standing in line. But that chance encounter in a California Starbucks turned into a handshake over dinner, a corporation filing within months, and a speech therapy practice that went from four treatment rooms to four clinic locations in under four years.
Five Oaks Speech Therapy Services is the largest practice to appear on Clinic Chats so far, and the story behind it reads less like a strategic business plan and more like two people who simply refused to slow down.
A Starbucks Meeting That Changed Everything
Renee and Christina had crossed paths before. They'd met years earlier at a CASHA convention in San Francisco, where Renee tried to recruit Christina to work in her school district. That didn't work out. Later, they communicated over client reports when Renee was supervising at a private practice and Christina was writing evaluations for another organization. Cordial. Professional. Nothing more.
Then came the Starbucks moment. Renee had already decided to leave the school district after 20-plus years and start her own practice. She'd filed her corporation and was scouting brick-and-mortar locations. Christina, ready to leave her own position, spotted Renee in line and asked a question that surprised them both.
"I said, hey, do you need a partner? And I didn't need a partner. I didn't want a partner. That wasn't my intention at all. But when she posed the question, I just went, well, I'm game for anything, because I don't know what I'm doing."
By December they were having dinner. By January their husbands were meeting. By July 2016, Five Oaks Speech Therapy Services held its grand opening in Grand Terrace, California, with Renee and Christina serving as the receptionist, the clinicians, the welcoming committee, and the cleaning crew.
Growing From a Waitlist, Not a Business Plan
The original clinic had four offices. Within a year, they had a waitlist. Within three years, they'd expanded in both directions and upstairs, turning that small suite into a 17-room operation. And they didn't stop there.
Five Oaks now has three locations across the Inland Empire (Grand Terrace, Wildomar near Temecula, and Rancho Cucamonga) with a fourth opening in Chula Vista, San Diego. They employ close to 50 people. They see roughly 135 to 145 patients daily across their clinics, serving both pediatric and geriatric populations.
That growth didn't come from a detailed five-year plan. It came from picking locations where the need was real and securing insurance contracts early. Renee and Christina never started as a private-pay-only practice. From the beginning, they pursued contracts with Kaiser, Easterseals, Health Net, Blue Cross Blue Shield, and eventually became Medicare and Medi-Cal certified.
"I don't think we've ever really started off with a private pay type thing. We had insurances initially from the beginning."
That decision to go all-in on insurance credentialing from day one set Five Oaks apart from many startups that ease into payer relationships over time. It also meant more billing complexity, more documentation, and more administrative overhead, all of which they had to learn on the fly.
Keeping Culture While Scaling Fast
Hiring nearly 50 employees in three years creates an obvious risk: losing the culture that made the practice work in the first place. Renee and Christina are aware of it, and they've been deliberate about protecting it.
Both partners still conduct interviews together. They look for a specific personality type, someone who fits the team dynamic they've built. It's only recently that they've started delegating the initial screening to clinic directors, and even then, Renee and Christina remain the final decision-makers.
"We've been able to maintain the culture here because Renee and I look for a certain personality in our hiring process to ensure that we have a good team."
They've also built out a real leadership structure. Renee serves as CEO, Christina as assistant CEO, and they've hired a CFO, an office administrator who handles billing and HR and payroll, and receptionists at each location. For two SLPs who never set out to be businesswomen, they've learned fast.
The financial side required sacrifice. Christina went unpaid for the first six months. Renee went nearly the entire first year without a paycheck. Everything went back into the business: rent, materials, therapy software, internet, lights. They established fixed salaries and a share structure through a business lawyer, with Renee holding majority shares and Christina's ownership growing over time.
Two Personalities, One Direction
What makes this partnership work, at least according to Renee and Christina, is that they're different enough to balance each other out. Renee describes herself as the experienced, cautious one. Christina is the younger, faster-moving one who wants to "take over the world." They meet somewhere in the middle.
"I like to think of myself as the old SLP and Christina's the new, young, fresh mind. And we meet somewhere in the middle. I'm kind of like, slow, hang on, slow down. And Christina's like, come on, old lady, let's go."
That balance extends to accountability. Christina is candid about the fact that as a newer SLP, she used to pile too much on her plate: caseload, management, supervision, all at once. Working with Renee taught her that in a business, things have to get done when they need to get done, because people are relying on you.
They're also thinking about what's next. Teletherapy is on the radar. So is expanding beyond speech into a multidisciplinary model. But they're realistic about the learning curve. Mastering the business side of speech therapy, the contracts, the HR, the credentialing, has already been its own education. Taking on occupational therapy or other disciplines means starting that learning process over again.
Humble Beginnings, Relentless Drive
Both Renee and Christina grew up in San Bernardino. They're straightforward about their humble beginnings and equally straightforward about their refusal to let those beginnings define their ceiling.
"Nothing is going to hold us back. You say no. Okay, well, we'll find a way around till we get to the answer we need."
Christina is expecting her second daughter and plans to take about eight weeks of maternity leave before returning to work. It's not bravado. She simply doesn't know any other way to function, and she wants to build something meaningful for her girls.
For practice owners who are still in the four-room stage, Renee and Christina's story is proof that growth doesn't require a fancy origin story or a meticulous business plan. Sometimes it starts with a chance meeting, a willingness to say yes, and two people who hold each other accountable every single day.
Scaling a multi-location practice means the back office has to keep up. ClinicNote is a HIPAA-compliant EMR built specifically for private practices and university clinics, handling documentation, scheduling, and billing across multiple locations so your clinical team can focus on patients, not paperwork. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist private practice podcast, a podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA compliant cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstadt, and thank you for joining me today. I'm joined with two partners in business. I've got Renee Robles and Christina Ramos, the owners of Five Oaks Speech Therapy Services. I appreciate that you both were available to join me today. How are you guys doing?
Renee: We are doing great. We're super busy. We happen to be in the same area for today.
Kadie: Well, being busy is a great, quote unquote, problem to have. So let's jump right in. Could one of you fill me in on the background of how you all got partnered together?
Christina: Okay. Well, our story is kind of a doozy. So I've been an SLP for over 20 years, and Christina is a newer SLP. We had met at a CASHA convention in San Francisco, and I was actually trying to recruit her. She was getting ready to graduate to come work for the school district that I was working for. And I interviewed her, and she came and toured my schools, et cetera, et cetera. But she went in a different direction.
Renee: And then I was also supervising at a private clinic, and Christina was writing some reports for this other entity. It's a rather big entity. And so we would communicate based on reports for clients that we were seeing at the clinic. And if I had questions, I'd call her up, and we kind of had a relationship that way.
Christina: Well, 20-something years into the school district, I was done with the district, and I happened to... I didn't happen. I was always at Starbucks in the morning. That's possible. Yeah. And I typically would get Starbucks on certain days. And for this day in particular, I decided to actually go into the Starbucks instead of going through the drive-thru. So I was waiting for my coffee, and in came Renee with one of her colleagues. And I recognized her right away. And so I was like, Renee. And it took her a second to recognize me, but granted, I had cut and colored my hair.
Christina: And we started chatting, and she was basically asking me, like, hey, what's going on there with your job? Because you guys are behind on this and this, and in true Renee fashion, letting me know. And so her colleague kept kind of elbowing her, like, you know, give it to her, give it to her. And I was like, give me what? And that's when Renee let me know that she was going to start to do her own thing. She wanted to start her own private practice.
Christina: And I was at the point where I knew that I didn't want to stay at the company I was in. I needed to find something else. And so I had been in private practice before as an SLPA, as a speech language pathology assistant. And I liked private practice. And so I asked her, I said, hey, do you need a partner?
Renee: And I didn't need a partner. I didn't want a partner. That wasn't my intention at all. But when she posed the question, I just went, well, I'm game for anything, because I don't know what I'm doing. I'm going into this blindly. And Christina seems like an okay person. So I told her, if you're really serious, let's go have dinner. We went to dinner the next week and hit it off and decided, well, let's do this. So we jumped in together. And here we are.
Kadie: Wow. So what was that timeline? When did all of this begin?
Renee: Wow. Okay. So we started talking and it was in November, right? When we went out to dinner.
Christina: We went out in December. We went out in December. It's in my planner.
Renee: Okay. And we met again in January with the husband. Our husbands met because we want to make sure if we're going to be in this relationship, our husbands have to be able to get along as well. The husbands met, the four of us went to dinner, we all hit it off.
Christina: And then you had already had places lined up that you were looking for the brick and mortar location. And so that was in early. So this is January 2016.
Renee: Okay. Yes. And so Renee already had, was already in contact with somebody that was helping her find locations for clinics. And so then I kind of started going along with her to visit these locations. I quit my job in January.
Christina: And from there, right, we decided in the location, we decided we were going to be in Grand Terrace. Yeah. Chris went and took another position and waited a while. And then we actually opened, our grand opening was in July, right. And we opened, Chris and I, when we opened, we were the receptionist, we were the clinicians, we were the welcoming committee and the cleaning crew.
Renee: Then I don't know. We kept hitting little, kept trying to hit little benchmarks like, hey, we're going to get 20 patients and we're going to get, you know, 40 patients and 50. And just for your information, that little office that we opened up at with four offices now has 17 rooms.
Kadie: Oh my goodness. Did you just expand on what the space originally had or how did that work?
Renee: Yes. We expanded one direction and then there was some other people in the other office and we kind of said, hey, we want to take over this. Are you guys going to be staying longer? And they said, we're moving. So we're like, great, we'll take over that. So in a matter of three years, we expanded both directions and upstairs.
Kadie: Wow. And so how many therapists do you all employ or contract with now?
Renee: Well, here's the thing. That was our first office. We are now getting ready to open our fourth clinic.
Kadie: Oh my goodness.
Christina: So every year we open up a new brick and mortar facility.
Kadie: So this is big. And do they all, are they all under the name Five Oaks Speech Therapy Services?
Renee: Yes.
Kadie: And then they kind of find the location that works best for them?
Christina: Yes. So what we do is we kind of see where we think the need is, scout out the area and go to that area. First location is in Grand Terrace, California, and then, which is in the Inland Empire. And then we have one, our second location, which is in Wildomar, which is near Temecula. And we have our third location, which is in Rancho Cucamonga, and we are just getting ready to open up number four down in San Diego area, way down in San Diego in Chula Vista.
Kadie: Wow. To answer your initial question, we have, right now we're close to 50 employees.
Renee: Yes.
Kadie: So I imagine at this point you are strictly business owners to manage that many employees? Or are you still seeing a caseload?
Christina: So basically, Renee has attachment issues. And so she still carries a very small, small caseload, who is very flexible with her. You know, they know when things come up and she may not, you know, we reschedule and they kind of work around her schedule. At this point, it's the adults that she sees that she's had for a long time.
Renee: Yeah. So I still currently do assessments when we need them done. If, you know, we absolutely have to have them done, I'm here to do assessments. But I will say that it's not nearly the caseload we carried, even like, even compared to last year.
Christina: To do most of the business aspect, you're correct. We weren't businesswomen by all means, but we have, man, so I'm the CEO, Chris is assistant CEO. We have a CFO. We have an office administrator. We have the whole gamut. And it takes all of us together cooperating, running this little ship that we're sailing here.
Kadie: Don't say little. You are by far the largest that I have gotten to speak with thus far. And I just can't believe the growth in such a short amount of time. So what's been the secret?
Christina: Well, I think it's the area that we try to pick that has the need. But also we have major contracts with insurances. I don't think we've ever really started off with a private pay type thing. We had insurances initially from the beginning. So we have contracts with Kaiser and Easterseals. We're working on Dignity Health. We have Health Net. We have Blue Cross Blue Shield. We also do private pay and we are Medicare and Medi-Cal certified now.
Renee: The need is there. I mean, one of our areas that we are in, there's, I think, three practices in Rancho Cucamonga right by us that there's a need. Yes, absolutely.
Kadie: And are your therapists below you all hired as full or part-time employees or all contractors?
Renee: They're all employees.
Kadie: Oh, okay. So whenever it's time for you to hire someone on, are both of you doing the interviews and the paperwork for that or do you kind of divvy up those roles and have an accountant?
Christina: We do have an accountant. Our accountant keeps us, you know, we have to mind our P's and Q's because of the amount of patients we see and the amount of transactions we have. We are averaging about 100 and a little more, but I think about 135, 145 patients daily between the three clinics right now.
Kadie: Wow.
Renee: Yeah. And we are pediatric and geriatric, so we have both pediatric patients and adults, but we do have our own accountant as well.
Christina: But as far as the hiring and interviewing, Renee and I still do the interviews together because we've been able to maintain the culture here, I think, because Renee and I, we look for a certain, I think a certain personality and in our hiring process to be able to ensure that we have good, you know, a good team. And so her and I are still doing the interviewing.
Christina: And then just this morning, I just did orientation for a new hire. But as we are expanding, you know, we've hired more like, and I don't want to, I guess, I don't know if permanent is the right word, but, you know, we're now hiring SLPs who are helping kind of manage the clinics and help us manage clinics and manage personnel. And so we slowly started to let some of the interviewing, you know, go to the clinic directors first and then come to us, you know, and hiring the hiring process and the scouting process go to them first. And then, you know, we're kind of the secondary on that now.
Renee: Which is difficult. Renee and I are both control freaks.
Kadie: I imagine that's difficult. And I just, did you have any idea that you wanted or even could grow a practice this big?
Renee: Absolutely not. No.
Christina: Probably every week we look at each other and go, oh my gosh, like, you know, when we started with our little four rooms, it was like, okay, we have some room to grow if we need it. And within the year, we were like, we have a waitlist, we have to grow. Oh my gosh.
Christina: And look where we're at now. We just kind of every day go, but let me tell you, we're constantly in contact, Christina and I, we have to be, you know, pretty much on the same page all the time because we work together very well. I like to think of myself as the old, old SLP and Christina's the new, young, fresh, you know, mind. And we meet somewhere in the middle. Because I'm kind of like slow, hang on, slow down. And Christina's like, come on, old lady, let's go.
Christina: You know, so we somewhere in the middle and I, you know, and the thing is, is, you know, you have to have someone that holds you accountable. And so I've learned just tenfold from Renee because as a newer SLP, you know, sometimes you just, you put too much on your plate and you're like, I could do it. I could do it. I could do it. Right. Like I want to caseload and I want to manage and I'm going to supervise and I'm going to do all this. And then things start falling off and you can't have that in a business. You know, some things have to be done, you know, when you say they need to be done because people are relying on you. And so I think we both have learned from each other and have had a good balance.
Kadie: Yes. And so I'm sure day to day or week to week, everything probably changes and you never know what you're going to have to do each day. But do you all have a main office where you like to work or do you kind of just divide and conquer and go all over the place?
Renee: Well, that's why we happen to be in the same place today, because we have, we're in this divide and conquer, you know, kind of now. I try to stay over in the area closer to where I live because I live quite a bit of ways. And so I'm trying to stay at that office, particularly a little bit more. Christina stays at this office that we're at now, which is in Grand Terrace office. And then we have another SLP that's full time at our other office. So we're trying to be available all the time at each particular place. But sometimes it's required that Christina and I get together because we not only just talk on the phone, but we need to get together and do some paperwork or whatever.
Christina: Plus, I like to see her.
Kadie: The main forces need to touch base. That's for sure. Yeah. And as far as business model goes, whenever you first sat down three years ago or so, did you have to talk numbers? Okay, how are we dividing this? I'm sure at that time, it looked a little bit different than what it evolved to. But after paying employees, after paying all your expenses, what does that breakdown look like?
Renee: Well, yeah. And the thing is, is because I actually had started my corporation the year before we actually opened up the brick and mortar. So I had my corporation already. I just have the brick and mortar play stand. And then when Christina came on, we also have a business lawyer that we have. And so we had to go in and change the way that the shares are divvied out and how that all runs. So we all go by how much we divide our shares of the corporation, and it's all laid out through our corporation, how many shares that she'll get as the years progress. So it's all laid out. We've all agreed to it. It's all signed. It's all documented with our lawyer. So that's kind of the discussion that we knew from the beginning, this is how we're going to work it.
Christina: The first year, because we were starting out, I went unpaid for six months and Renee went nearly the full year because we had to use everything to keep the business alive and growing. Employees, we had to pay rent. We had to pay for materials, everything, like internet, lights. And so we established that we were going to be paid a fixed salary, which is just what we agreed upon. And again, everything after that is divided by the amount of shares that her and I both share. And Renee is a majority shareholder right now.
Kadie: Where do you think things are going to move in the next five years? Can you even imagine the growth that could happen?
Christina: Well, there's a couple of, you know, Christina wants to take over the world.
Renee: I think we could be everywhere. Yeah.
Kadie: Are you thinking teletherapy?
Christina: We've thought about teletherapy. We have also thought about expanding because we're speech only. Wow. But maybe expanding to a multidisciplinary team. It's difficult because we know speech, you know, so when it comes down to things, we know speech and we've had to learn the ins and outs of, you know, when you start a business and you're going and you have these ideas of, I'm going to do speech therapy and we're going to provide speech for the community. And it's like, yes, that's what it is. But on the back end, you're doing billing, you're doing contracts, you're doing HR, human resource things and your certifications. And it's kind of like, whoa, this isn't just speech anymore. This is a whole other entity and animal that we've had to learn about.
Renee: Oh, yeah. When you take on these other practices, it's like, oh, I don't know if I have the energy to learn all the billing and how that all works as well.
Kadie: And are you doing your own billing or is that hired out at this point?
Christina: No, we have our office administrator who does all of our billing. He does all of our codes. He does all of our human resources. He does our payroll. He kind of wears the hat for all of that.
Kadie: Wow. And then is there a receptionist then at each facility?
Renee: Yes. This one has two.
Kadie: Oh, I gotcha. Well, I just am amazed that it kind of started just in hopes of doing your own thing, getting out of the schools, et cetera, and has blossomed into this huge thing where now you're dreaming up what's the next big idea because we can make it happen.
Christina: Yeah, I think Christina and I, you're talking about two girls that grew up in San Bernardino and I don't know if you're familiar with San Bernardino at all. It's in the Inland Empire. Listen, we're, I mean, it just is what it is. Very humble beginnings.
Renee: Yes, very humble beginnings. But both of us have drive and determination and nothing is going to hold us back. You say no. Okay, well, we'll find a way around till we get to the answer we need. And one door closes, the other one will open. It's okay. We'll figure it out.
Kadie: And Christina, Renee was telling me earlier that you are pregnant with your second baby. They're close together. How are things going to continue to run smoothly while you take a little time for you and the baby?
Christina: Well, you know, we learned from my last pregnancy. And Renee and I function under transparent communication. And so I, you know, I am very fortunate. I have a lot of support. I do. I have a great support system. My mother is retired and so she watches my little girl now and she'll help me with the second and my husband is very flexible and he helps a lot. And so I will continue, you know, to work. I will be off on maternity leave for, you know, probably about eight weeks and hope it all goes well and everything, you know, baby's good and, you know, everyone's healthy and I will come back and I will work.
Kadie: You're ready to jump right back in.
Christina: It's, you know, I just, I don't know that I know any other way to function and having my first baby and having that experience, I needed to come back to work. Work was really important for me and it helped me a lot.
Renee: That's true. Returning to normalcy.
Christina: It's important, you know, I'm going to have another daughter and so for me, I know for me it's really important to be able to establish something really great for my daughters.
Kadie: How amazing. Well, I'm sure you'll do awesome with the second baby and then just rock it right back into the workforce, which I mean, who doesn't need a little adult interaction to continue functioning, right?
Christina: Right. I just, when I come here, I feel like I can have a meal, you know, without interruption. So this is honestly a break. So funny.
Kadie: Yes. The first like two, three months of my son's life, I thought, oh, I need to be a stay at home mom. This is what I need to do. And then after they reach a certain point, it's like, no, I need to work.
Kadie: Well, I appreciate hearing about this amazing and fast growing business. I'm going to have to follow your story because I can't wait to see what happens in the years to come.
Renee: Well, thank you.
Christina: Thank you for sharing your story. No, thank you for having us. And we enjoy being able to obviously tell our story because we hope that other people can hear it and say, hey, you know what, I can do this. This is possible. It's just, you know, it does take a lot of work. A hundred percent. Lots of work.
Kadie: Thank you for joining me and listening to Clinic Chats, the speech therapist's private practice podcast. If you have a moment, please leave a five star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey through private practice, please email me kadie@clinicnote.com, that's K-A-I-D-E at clinicnote.com.