Before a med spa can administer Botox, fillers, or laser treatments, it must satisfy the same good faith exam requirements as every other state. A licensed provider reviews the patient’s medical history, performs a physical exam, and documents a clear treatment decision before care begins. States build extra rules on top of that baseline, but none of them let a practice skip the exam itself.

The Baseline Requirement Every State Shares

Every state that regulates aesthetic medicine classifies prescription-based treatment, including injectables, energy devices, and prescription skincare, as the practice of medicine. That classification requires a provider-patient relationship before treatment begins, regardless of what the state calls the exam that establishes it. Some states call it a good faith exam, while others call it an initial exam or an appropriate prior examination.

• What counts as the trigger: Injectables, energy devices, and prescription skincare treatments all classify as the practice of medicine and require this relationship before treatment.
• What establishes the relationship: A documented medical exam and clinical decision establish it, not a signature on a general waiver or consent form.
• Who cannot establish it alone: Registered nurses, medical assistants, and estheticians cannot create this relationship on their own, even with a standing order in place.

From here, individual states add their own rules about exactly who can perform the exam, how it must be delivered, and how often it has to be repeated.

The Three Things Every Requirement Covers

Every state’s good faith exam requirement comes down to three questions: who can perform the exam, what it must include, and how often it must be repeated. A compliant good faith exam policy addresses all three before a single patient is scheduled. Skipping any one of the three creates a gap that a board can flag during an audit.

• Who can perform it: A physician, nurse practitioner, or physician assistant with prescriptive authority must perform the exam, though full-practice-authority states let a nurse practitioner do this independently.
• What it must include: The exam must include a medical history review, a physical or visual exam relevant to the treatment, and a documented, patient-specific treatment decision.
• How often it must be repeated: Most states require a new exam at least annually, when the patient starts a new treatment type, or when enough time has passed that the patient’s health status could have changed.

A generic approval that skips the patient’s specific history and exam findings will not withstand board scrutiny, no matter which of the three boxes it checks. The exam has to tie directly to the patient in front of the provider.

Where States Actually Differ

Good faith exam requirements vary by state, most notably in three areas: telehealth permissibility, what technology meets the standard of care, and how often the exam must be renewed. The table below reflects current board guidance as of this writing, and that guidance changes often. Confirm the current rule with your state’s medical or nursing board before treating a patient based on the table below.

Every state on this list requires a licensed prescriber to conduct an individualized exam and document a specific order in the chart. What varies is how much flexibility each state gives to telehealth and how strictly it defines acceptable documentation.

What Happens When Requirements Aren’t Met

Skipping or shortcutting a good faith exam does not save time. It shifts risk onto the practice, the supervising physician, and the patient. That risk lands in three places: board discipline, malpractice exposure, and practice valuation.

• Board discipline: State medical and nursing boards treat a blank template or a form with no patient-specific findings as a missing exam, not a completed one.
• Malpractice exposure: If a patient has an adverse reaction, a thin or generic exam note makes it harder to show the provider assessed contraindications before treatment.
• Reduced practice valuation: Buyers auditing clinical workflows during a sale or acquisition often reflect missing good faith exam documentation in a lower offer.

All three risks trace back to the same gap: documentation that does not show the provider evaluated that specific patient. Fixing the exam process at the documentation level closes all three exposures at once.

How Medical Director Co. Keeps Requirements Covered as They Change

Good faith exam rules change as states update telehealth standards and documentation expectations. Medical Director Co. provides ongoing physician oversight that reviews your exam workflow and delegation agreements against current requirements in your state. This keeps your practice aligned with the rule in effect now, not the one that applied when you built your protocol.