Good Faith Exam (GFE) Laws: State-by-State Aesthetic Regulations
Executive Summary
Prescription aesthetic treatments, such as neurotoxins, dermal fillers, and prescription IV nutrients, are regulated as medical care, so states require a licensed practitioner to evaluate the patient and authorize the treatment before it is given. The industry calls that evaluation a Good Faith Examination. What it must include, and who may perform it, is set state by state, so read the rule your own state applies.
Key Legal Realities:
- ✓Who May Examine Is Set by State Law: The evaluation is performed by a physician, or by a nurse practitioner or physician assistant where state law allows it, which in some states means practicing on their own license and in others means practicing under a physician's delegation or supervision. A registered nurse administers what is ordered and does not diagnose or write the order.
- ✓Telehealth Rules Are State Specific: California Business and Professions Code 2242(a) provides that an appropriate prior examination, before a licensee prescribes, dispenses, or furnishes a dangerous drug, does not require a synchronous interaction and can be achieved through telehealth, including a self-screening tool or a questionnaire, provided the licensee complies with the appropriate standard of care and there is a medical indication. Texas Occupations Code 111.005(a)(3)(B) permits asynchronous store and forward technology to establish the practitioner-patient relationship only where the practitioner uses clinically relevant photographic or video images or the patient's relevant clinical records, and section 111.007 holds the practitioner to the same standard of care that would apply in person. That is what those two statutes say, and it is not a finding about any other state.
- ✓A Written Protocol Is Not the Examination: Texas requires both: 22 Texas Administrative Code 169.26(a)(2) requires the person performing a delegated act to sign and date a written protocol, and 169.26(c)(1) separately requires a practitioner-patient relationship to be established before that act. Ask your own state's board how it treats standing orders.
The Legal Foundation of the Good Faith Exam
In the eyes of state regulatory boards, a medical spa is not a retail beauty salon — it is an outpatient clinical facility. Substances such as Botox, Dysport, Juvederm, and compounded vitamin infusions are legally classified as prescription drugs or restricted medical devices. Under federal and state laws, prescription medication can only be administered pursuant to an authentic patient-practitioner relationship.
The Good Faith Examination is the mandatory clinical encounter that establishes this relationship. During the examination, the licensed prescriber evaluates the patient's medical history, reviews past complications, confirms physical anatomy, rules out systemic contraindications (such as neuromuscular disorders or active infections), and issues a customized, signed medical order.
State-by-State Regulatory Deep Dive
1. Texas (Texas Medical Board, 22 Texas Administrative Code chapter 169, subchapter E)
Texas maintains some of the nation's strictest enforcement regarding medical spa compliance. The Texas Medical Board repealed 22 Texas Administrative Code 193.17 effective January 9, 2025 and moved these rules into chapter 169, subchapter E. Rule 169.25(a)(1) classifies nonsurgical medical cosmetic procedures, including injecting medication or substances for cosmetic purposes, as the practice of medicine that a physician may delegate. Before the delegated act, rule 169.26(c) requires a physician, or a physician assistant or advanced practice registered nurse acting under the delegation of a physician, to establish a practitioner-patient relationship, complete and maintain an adequate medical record, disclose the identity and title of the individual who will perform the act, and ensure at least one person trained in basic life support is present while the patient is onsite. Separately, rule 169.26(d) requires a physician, physician assistant, or advanced practice registered nurse to be onsite during the procedure or immediately available for emergency consultation, and if necessary the physician must be able to conduct an emergency appointment with the patient. Rule 169.26(a) also requires the delegating physician to ensure the person performing the act is trained for it and has signed and dated a written protocol, and rule 169.27 requires a written order that the physician has either reviewed and approved in writing or developed.
What subchapter E does not say: it does not name a required technology for the evaluation, and it does not use the words in person or synchronous. Texas Occupations Code 111.005(a)(3)(B) allows an asynchronous store and forward method to establish the relationship where the practitioner uses clinically relevant photographic or video images or the patient's relevant clinical records, and 111.007 applies the same standard of care that would apply in person. Read 22 Texas Administrative Code 169.25 to 169.28 for the full set of requirements.
2. California (Medical Board of California & BPC §2242)
California Business and Professions Code §2242(a) provides that prescribing, dispensing, or furnishing dangerous drugs as defined in Section 4022 without an appropriate prior examination and a medical indication constitutes unprofessional conduct. The same subdivision provides that an appropriate prior examination does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth, including a self-screening tool or a questionnaire, provided that the licensee complies with the appropriate standard of care. So section 2242(a) requires the examination and does not require it to be live. Who may perform it, and on whose license, is a separate question under the Medical Practice Act and the Nursing Practice Act.
Enforcement Note: Corporate Practice of Medicine (CPOM) is rigorously enforced in California. Lay-owned clinics cannot hire physicians directly; the medical entity must be physician-owned, ensuring clinical independence during the GFE process.
3. Florida (Florida Board of Medicine)
We did not reach a current Florida rule text for this guide, so nothing in this section should be read as a statement of Florida law. The rule this section used to cite, Florida Administrative Code rule 64B8-9.0075, was repealed effective May 7, 2012. Check the Florida Board of Medicine and the Florida Board of Nursing for the current rules, and ask the clinic which licensed provider evaluated you.
4. Georgia (Georgia Composite Medical Board)
We did not reach the Georgia rule text for this guide, so nothing in this section should be read as a statement of Georgia law. Check the Georgia Composite Medical Board's current rules on delegation, on practice by electronic means, and on laser practitioner licensing, and ask the clinic which licensed provider evaluated you.
5. Illinois (Illinois Medical Practice Act & Nurse Practice Act)
We did not reach the Illinois statute text for this guide, so nothing in this section should be read as a statement of Illinois law. Check the Illinois Medical Practice Act and the Nurse Practice Act, through the Illinois Department of Financial and Professional Regulation, for who may evaluate a patient and what a physician or an advanced practice registered nurse may delegate.
Warning Signs: How to Spot an Illegal or Non-Compliant Med Spa
Patients can protect their health and legal rights by watching for these four critical regulatory violations:
- No Evaluation at All: If nobody licensed to evaluate you and order the treatment has reviewed your history and authorized this treatment for you, ask who did and when. The evaluation is the step the rules turn on: in Texas, 22 Texas Administrative Code 169.26(c)(1) requires the practitioner-patient relationship to be established before the delegated act.
- Automated Approval With No Clinician: An intake form that returns an approval in seconds with nobody licensed reviewing it is a different thing from a lawful asynchronous review. California Business and Professions Code 2242(a) conditions the telehealth route on the licensee complying with the appropriate standard of care, and Texas Occupations Code 111.005(a)(3)(B) requires the practitioner to use clinically relevant images or your relevant clinical records, subject to the standard of care in 111.007. Ask who reviewed your information and what license they hold.
- Unlicensed Injectors: Estheticians, medical assistants, and dental hygienists are strictly prohibited from performing neurotoxin or dermal filler injections in almost every US jurisdiction, regardless of whether a GFE was conducted.
- Refusal to Disclose the Medical Director: A legitimate medical spa will proudly display its Medical Director's name, credentials, and state license number on its consent paperwork and in clinic signage.
Related Legal & Safety Guides
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Frequently Asked Questions
Can a Registered Nurse (RN) perform a Good Faith Exam?
No. A registered nurse administers what is ordered and does not diagnose or write the order. The evaluation is performed by a physician, or by a nurse practitioner or physician assistant where state law allows it, which in some states means practicing on their own license and in others means practicing under a physician's delegation or supervision. Ask the clinic which licensed provider examined you and verify the license with the state board.
Are telehealth Good Faith Exams legal in all states?
Telehealth rules are set state by state, so there is no single answer. In California, Business and Professions Code 2242(a) provides that an appropriate prior examination, before a licensee prescribes, dispenses, or furnishes a dangerous drug, does not require a synchronous interaction and can be achieved through telehealth, including a self-screening tool or a questionnaire, provided the licensee complies with the appropriate standard of care and there is a medical indication. In Texas, Occupations Code 111.005(a)(3)(B) permits asynchronous store and forward technology to establish the practitioner-patient relationship only where the practitioner uses clinically relevant photographic or video images or the patient's relevant clinical records, and section 111.007 holds the practitioner to the same standard of care that would apply in person. Those are findings about those two statutes only, not about other states. Rules change, so read the current rule for your state and ask who reviewed your history and what license they hold.
What happens if a med spa treats a patient without a Good Faith Exam?
That turns on the state's own rules and on the facts, so this guide cannot tell you what any particular clinic has done. What the rules we read require is narrower and clearer: in Texas, 22 Texas Administrative Code 169.26(c)(1) requires the practitioner-patient relationship to be established before a delegated act, and in California, Business and Professions Code 2242(a) makes prescribing, dispensing, or furnishing a dangerous drug without an appropriate prior examination and a medical indication unprofessional conduct. State medical boards take complaints.
Does a Good Faith Exam expire?
We did not find a fixed interval in the rules we read: California Business and Professions Code 2242 and the Texas Medical Board delegation rules at 22 Texas Administrative Code 169.25 to 169.28 set none. That is a finding about those rules only, not about other states, so check the rule where you are treated. Many clinics and malpractice carriers set their own policy, often a year. Any significant change in medical history, pregnancy, new medications, or a new type of treatment is a reason to be evaluated again whenever it happens. Rules change, so ask the clinic what its current policy is and who performs the re-evaluation.
Editorial and Medical Disclaimer: Content on Medical Spa Providers is for informational, educational, and consumer-vetting purposes only and does not constitute formal medical or legal advice. Always schedule an in-person consultation with a licensed healthcare provider before undergoing clinical aesthetic procedures.
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