Good-faith exam — by State
51 of 51 states require a good-faith exam
51 of the 51 US jurisdictions (50 states plus the District of Columbia) require a good-faith exam; the remaining 0 do not. The table below gives each state's rule in its own words, with the statute or board rule it comes from.
Good-faith exam in all 51 US jurisdictions
| State | Good-faith exam |
|---|---|
| Alabama | A physician (or a PA/CRNP/CNM working under a legal registration/collaboration agreement) must personally perform an individualized evaluation, diagnose the patient, and establish a physician-patient relationship before any drug is prescribed or administered; BME rules require the physician's examination of the patient prior to prescribing (Ala. Admin. Code r. 540-X-9-.11(1)). The Board's IV-therapy declaratory ruling confirms this evaluation and treatment 'may occur in person or utilizing telemedicine' under Ala. Code § 34-24-703(b). |
| Alaska | No statute imposes a med-spa-specific good-faith-exam mandate, but AS 08.64.364 governs prescribing/treating without an in-person physical exam: the Medical Board may not discipline a physician or PA for diagnosing, treating, or prescribing a non-controlled drug without a physical exam if a provider in the practice is available for follow-up and records are offered to the patient's primary care provider — expressly permitting telemedicine (12 AAC 40.967(29)(D)). However, a prescription may NOT be issued in response to an internet questionnaire where no prior physician-patient relationship exists (AS 08.64.364(c)(2)). A bona fide provider-patient evaluation is therefore effectively required, and it may be conducted via telehealth rather than in person. |
| Arizona | A good-faith exam is required: the Board of Nursing advisory opinion states that prior to any medical aesthetic treatment an initial face-to-face examination must be performed by a qualified licensed practitioner, and that a licensed-practitioner order is required to initiate all Level II and III procedures (injectables, laser, IV). The IV-therapy advisory reinforces this — an RN/LPN must have an individualized order from a provider who has established a patient relationship and completed an examination before ordering. Telehealth is permitted: telemedicine may be used for the initial exam and the supervising practitioner may be available by telecommunication. |
| Arkansas | Arkansas does not use the statutory term 'good faith exam,' but requires its functional equivalent. Aesthetic procedures 'shall be prescribed by a qualified physician or an APRN with prescriptive authority,' and an RN performs them only under a patient-specific order from the delegating physician/APRN that includes a patient-specific diagnosis (AR Board of Nursing Position Statement 21-1). The underlying physician-side requirement is Arkansas State Medical Board Regulation No. 2, Section 8 ('Requiring minimum standards for establishing physician/patient relationships'), not Regulation 22 (which is the Laser Surgery Guidelines regulation and contains no diagnose-before-delegate/prescribe provision). Regulation 2, Section 8 provides that a physician exhibits gross negligence — a ground for license discipline under Ark. Code Ann. § 17-95-409(a)(2)(G) — if he provides or recommends any treatment, including prescribing legend drugs, without first establishing a proper physician/patient relationship, defined at minimum as either (a) a history and physical examination adequate to establish a diagnosis and identify contraindications to the treatment, or (b) personal knowledge of the patient's general health status through an ongoing personal/professional relationship, with appropriate follow-up. Telehealth can satisfy this: under the Telemedicine Act, telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter, and the relationship is NOT established solely through an internet questionnaire, email message, patient-generated medical history, text messaging, facsimile, or any combination of those (A.C.A. § 17-80-403). |
| California | A good faith prior examination is required before furnishing the dangerous drugs and prescriptive devices used in cosmetic injectables (BPC 2242), and it must be performed by a licensed prescriber (physician, NP, or PA), not delegated to an RN. The statute expressly permits the exam to be conducted via telehealth, including asynchronous self-screening tools or questionnaires, provided the licensee meets the standard of care. |
| Colorado | Colorado does not codify the specific term 'good faith exam' for aesthetics, but Rule 800 requires delegated medical-aesthetic services to be provided in the context of an appropriate physician/patient relationship, with the physician performing an initial consultation and reviewing care; a prescriber must likewise establish a valid provider-patient relationship before prescribing the drug. Telehealth technologies may be used to establish the relationship and provide the physician's consultation or follow-up, but the delegating physician should not rely exclusively on telehealth for supervision. |
| Connecticut | CGS § 19a-903c(c) requires a physician, PA, or APRN employed by or under contract with the med spa to perform an initial in-person physical assessment of each patient before any cosmetic medical procedure is performed. The 2015 amendment (P.A. 15-242) deliberately inserted the words 'in-person,' so a purely telehealth good-faith exam does not satisfy Connecticut's med-spa requirement. |
| Delaware | Delaware has no cosmetic-specific "good faith exam" statute, but a prescriber must establish a diagnosis and treatment plan before ordering prescription treatment. The telehealth statute (24 Del.C. § 6003–§ 6004) requires a provider-patient relationship established in-person or by telehealth—including history, examination and diagnosis—and prohibits issuing prescriptions solely in response to an internet questionnaire or telephone consult; the Board's delegation rule (§ 11.1.3) requires direct physician presence whenever a diagnosis is rendered or a prescription treatment plan is instituted. |
| District of Columbia | Before providing treatment or prescribing medication, a physician (or authorized prescriber) must perform a patient evaluation adequate to establish a diagnosis and identify contraindications (Board of Medicine Telemedicine Policy §§ 1.3, 1.6, referencing the binding rule 17 DCMR § 4618.7). The evaluation need not be in person — where there is no prior face-to-face interaction, the practitioner may establish the relationship and perform the evaluation via real-time auditory, or real-time visual and auditory, telemedicine (§ 1.8). |
| Florida | Florida statute does not use the term 'good faith examination,' but because injectables and IV drugs are prescription items a prescriber must first conduct a patient evaluation sufficient to diagnose and treat before ordering the treatment. Under the telehealth act that evaluation may be done remotely: a provider who conducts a telehealth evaluation sufficient to diagnose and treat 'is not required to research a patient's medical history or conduct a physical examination' in person beforehand, so an in-person exam is not mandated when the telehealth evaluation is itself adequate. |
| Georgia | A prior patient evaluation is required. The Board FAQ states the physician should examine/prescribe before an RN/PA/APRN injects; the IV Hydration/Therapy Position Statement requires a completed history & physical by a physician, NP, or PA and says standing orders are not a substitute for an individualized order and H&P; and cosmetic-laser Rule 360-35-.05 requires patients be examined by a consulting physician (or a PA/APRN cosmetic laser practitioner) before any laser service other than hair removal or pulsed-light treatment. Georgia's telemedicine Rule 360-3-.07 permits establishing the patient relationship and evaluating by electronic means, held to the same standard of care as in-person care (though it bars electronic prescribing of controlled substances for pain, which does not implicate typical aesthetic/IV services). |
| Hawaii | Hawaii has no med-spa-specific 'good faith exam' statute, but its telemedicine law (HRS 453-1.3) requires a documented patient evaluation, including history and a discussion of physical symptoms adequate to establish a diagnosis and identify contraindications, before treatment or prescribing, and provides that issuing a prescription based solely on an online questionnaire is not an acceptable standard of care. Telemedicine is expressly permitted to establish the provider-patient relationship and evaluate a patient, so a good-faith evaluation may be conducted remotely. |
| Idaho | The Board of Medicine cosmetic rules require the supervising physician to 'document an adequate legible patient record of his evaluation, assessment and plan for the patient prior to the initial cosmetic treatment' — Idaho's functional good-faith exam. An APRN or PA with prescriptive authority may perform the evaluation within their own scope. Whether this exam may be conducted by telehealth is not expressly addressed in the cosmetic-treatment rules, so telehealth performance is not confirmed. |
| Illinois | A good-faith examination is required. IDFPR's Statement on Prohibited Practices states that for delegated medical procedures at a medspa (e.g., Botox, chemical peels, collagen injections, microneedling, Radio Frequency), 'the person receiving the services must be a patient of the physician (there must be a physician/patient relationship), the physician must examine the patient and determine the appropriateness and the course of treatment.' The IDFPR/IDPH medspa memo confirms this applies to lasers too: 'The physician must examine the patient and determine an appropriate course of treatment before laser procedures are performed.' No fetched Illinois primary source authorizes performing this physician exam via telehealth for cosmetic injectables (Botox, fillers, weight loss injections) — the general telemedicine statute, 225 ILCS 60/49.5, is a jurisdictional/licensing provision for out-of-state practitioners and does not address the in-person-vs-telehealth standard for a medspa good-faith exam. The only telehealth-adjacent carve-out found is narrower and laser-specific: for non-ablative laser procedures only, the memo states a physician may satisfy on-site supervision by instead 'be[ing] available by telephone or other electronic means to respond promptly to any question or complication,' and, per a Medical Practice Act amendment effective January 1, 2025, an on-site physician exam before a non-ablative laser procedure is not required at all if (1) the facility follows a physician delegation protocol, (2) the exam is instead performed by an APRN, (3) the procedure is delegated to and performed by a trained RN/LPN, and (4) the physician remains available by phone/electronic means for questions or complications. That is delegation of the exam to an APRN (or a documented waiver for non-ablative laser only), not a physician conducting the good-faith exam itself via telehealth, and it does not extend to cosmetic injectables. Given the absence of any source blessing telehealth for the physician's own good-faith exam, telehealth_ok is set to false. |
| Indiana | Indiana has no med-spa-specific 'good faith exam' statute, but because injectables are prescription drugs, a prescriber must establish a proper provider-patient relationship meeting the same standard of care as in-person care before prescribing (IC 25-1-9.5-7). A prescriber may issue the prescription even without a prior in-person exam if the applicable standard of care is satisfied and it is within the prescriber's scope, so the evaluation may be conducted via telehealth (IC 25-1-9.5-8). |
| Iowa | Iowa has no med-spa-specific 'good faith exam' statute, but because medical aesthetic services are the practice of medicine, the telemedicine/standards-of-practice rule applies: a licensee must establish a valid physician-patient relationship and, prior to providing treatment or issuing prescriptions, interview the patient for relevant medical history and perform a physical examination sufficient for diagnosis (653—13.11(7)–(8)). The exam may occur by telemedicine when the technology is adequate to reach an informed diagnosis as if done in person, but a static internet questionnaire is expressly not acceptable. |
| Kansas | Kansas has no statute that uses the term 'good faith exam,' but the requirement follows from the healing-arts framework: diagnosing a patient and deciding to furnish/prescribe medication is itself the practice of the healing arts (K.S.A. 65-2869), so a licensed prescriber (physician, APRN, or PA) must personally evaluate and diagnose the patient and issue an order before injectables or IV medications are administered by anyone (see AG Op. 94-142 and the delegation limits of K.S.A. 65-28,127). That evaluation may be conducted by telehealth: the Kansas Telemedicine Act (K.S.A. 40-2,212) expressly allows a valid provider-patient relationship to be established via telemedicine, held to the same standard of care as in-person care. |
| Kentucky | A good-faith prior examination and a valid practitioner-patient relationship must be established by a physician, PA, or APRN — who personally evaluates the patient, forms an individualized diagnosis, and issues the order — before treatment is provided or a prescription (e.g., Botox or IV therapy) is issued, and diagnosis/prescribing based solely on a static online questionnaire does not meet the standard of care. The relationship may be established via telemedicine when the applicable standard of care is met, but merely naming a physician/PA/APRN as 'medical director,' 'on staff,' or 'available' while only an RN actually sees the patient is insufficient. |
| Louisiana | A good-faith evaluation is required before treatment: aesthetic procedures must be preceded by a history and appropriate physical exam and a diagnosis by a qualified physician (or an NP practicing in collaboration with one), and the LSBME's IV-therapy position requires a 'full in-person or virtual history and examination' establishing a bona fide doctor-patient relationship. Telehealth is expressly permitted to establish that relationship, but pre-set menus and blanket 'standing orders' in lieu of individualized evaluation are unlawful. |
| Maine | The joint Board of Licensure in Medicine / Osteopathic / Nursing telehealth rule (Ch. 11) requires a licensee to establish a valid licensee-patient relationship and, before providing treatment or issuing prescriptions, to interview the patient and perform a pertinent physical exam as defined by the standard of care. A static internet questionnaire does not satisfy this. The exam may be conducted via telehealth if the technology is sufficient to establish an informed diagnosis as though performed in person. |
| Maryland | Yes. Before a delegated cosmetic medical procedure, the physician must 'personally perform the initial assessment of each patient' and 'prepare a written treatment plan for each patient, including diagnosis and planned course of treatment' (COMAR 10.32.09.05). Maryland's telehealth rule (COMAR 10.32.05.05) permits a synchronous or asynchronous clinical evaluation appropriate to the patient before treatment or prescribing, so the required evaluation can generally be done via telehealth — though the cosmetic rule's demand that the physician 'personally' assess and the hands-on nature of injectables make an in-person exam the safer practice. |
| Massachusetts | Massachusetts has no med-spa-specific 'good faith exam' statute, but under the standard of care a prescriber must establish a valid practitioner-patient relationship and evaluate the patient before ordering prescription treatments such as injectables. That evaluation may be conducted by telemedicine: 243 CMR 2.01(4) recognizes telemedicine as a mode of practicing medicine, and the 2020 telehealth law (St. 2020 c. 260, adding M.G.L. c. 112 §5O) requires that telehealth meet the same standard of care as in-person care and does not require a prior in-person visit. (The §5O statute text itself could not be retrieved from the state portal, which is reflected in the confidence rating.) |
| Michigan | Michigan has no explicit statutory 'good faith exam' mandate for med spas. Because injectables and other cosmetic-medical treatments require a prescription drug, a prescriber must be acting within his or her scope of practice, and delegated care must be authorized and supervised by a physician (or NP/PA within scope) — failure to properly evaluate a patient is negligent delegation/care actionable under MCL 333.16221. Michigan expressly permits the evaluation and prescribing to occur via telehealth under MCL 333.16285, provided the prescriber acts within scope and arranges appropriate follow-up. |
| Minnesota | Minnesota has no statute that uses the term "good faith exam," but the requirement is effectively imposed because legend drugs may be prescribed and administered only "in the course of professional practice," and diagnosing/treating and prescribing are the practice of medicine — meaning a qualified provider must evaluate the patient and issue the order before treatment. That provider-patient relationship may be established through telehealth, and the telehealth encounter is held to the same standard of care as an in-person visit. |
| Mississippi | A good-faith exam is required before ordering any prescription treatment: MSBML rules require the physician to obtain a thorough medical history and conduct an appropriate physical and/or mental examination before prescribing any medication, and the joint Botox policy requires the collaborating physician to have examined the patient and documented chart approval before an NP injects. The exam may be conducted via telemedicine if the technology conveys the same information as a face-to-face exam, but a simple questionnaire without an appropriate exam violates Board policy. |
| Missouri | Before treatment, an authorized prescriber (physician, APRN, or PA) must evaluate and diagnose the patient and initiate treatment within the collaborative practice arrangement, whose rule frames delegated care around diagnosis, initiation of treatment, and periodic physician chart review. Missouri's telemedicine statutes (RSMo 334.108 / 191.1146) allow that physician-patient relationship to be established by telehealth when the standard of care does not require an in-person visit; because the state statute portal was IP-blocked from this environment I could not quote that text directly, so telehealth_ok is marked true at reduced confidence. |
| Montana | Montana has no cosmetic-specific 'good faith exam' statute, but because injectables and other cosmetic medical services must be prescribed and provided within the standard of care, the general prescribing rule applies: a provider must establish a provider-patient relationship and obtain a medical history and examination sufficient for diagnosis and treatment before treating or issuing prescriptions (ARM 24.156.813). That relationship may be established through telemedicine when the standard of care does not require an in-person encounter, so a properly conducted telehealth evaluation is permitted. |
| Nebraska | Nebraska's Board of Medicine and Surgery regulations make it unprofessional conduct for a physician to provide treatment or issue a prescription -- including via electronic or other means -- unless the physician has first obtained a history and physical evaluation of the patient adequate to establish a diagnosis and identify contraindications, functioning as a good-faith-exam requirement before cosmetic treatment or prescribing (172 Neb. Admin. Code ch. 88, § 009(F)). Telehealth is permissible: the Uniform Credentialing Act separately provides that any credential holder (physicians, APRNs, PAs, etc.) may establish a provider-patient relationship through telehealth and may prescribe a drug to a telehealth patient if otherwise authorized to prescribe under state and federal law, with narrow carve-outs (cosmetology, massage therapy, dialysis technicians, etc.) that do not include medicine (Neb. Rev. Stat. § 38-1,143). The Nebraska Telehealth Act (§§ 71-8501 to 71-8508) governs Medicaid telehealth reimbursement and pre-consultation informed-consent disclosures (§ 71-8505 requires only written disclosures/consent) -- it does not itself authorize establishing the provider-patient relationship or prescribing; that authorization comes from § 38-1,143 under the Uniform Credentialing Act, Neb. Rev. Stat. Ch. 38. |
| Nevada | A good-faith exam is required: the Board of Nursing's aesthetic practice decision requires 'an order for each individual intervention by a qualified licensed practitioner that has assessed the patient and established a bonafide patient/provider relationship' (citing NRS 639.235). Nevada expressly permits a licensed provider to establish care and write a treatment order or prescription via telehealth so long as the provider holds a valid Nevada license (NRS 629.515), so the exam may be conducted by telehealth. |
| New Hampshire | New Hampshire has no med-spa-specific good-faith-exam statute, but before a physician prescribes there must be a physician-patient relationship that includes an in-person or telemedicine exam, history, diagnosis, and treatment plan (RSA 329:1-c), and prescribing without one is unprofessional conduct subject to discipline. RSA 326-B:2, I-a imposes the equivalent APRN-patient relationship (exam, history, diagnosis, treatment plan). Both statutes expressly allow the examination to be conducted via telemedicine. |
| New Jersey | New Jersey has no aesthetics-specific 'good faith exam' rule, but N.J.A.C. 13:35-7.1A requires any practitioner, before dispensing drugs or issuing a prescription, to first perform an appropriate history and physical examination, reach a diagnosis, and discuss a therapeutic plan with the patient (all documented in the record) — a requirement that applies to injectable neuromodulators such as Botox, which are prescription drugs. (The rule's own exceptions allow the exam to be performed by a healthcare professional in collaborative practice with the prescriber, e.g., a supervising physician's PA or APN, so the exam itself can be delegated within that arrangement — it is not limited to the treating MD/DO personally.) Dermal fillers are likewise treated as a physician-jurisdiction medical service under New Jersey law: the Board of Cosmetology and Hairstyling's rules confirm the BME has determined 'laser hair removal and injections of Botox, Restylane or other similar medications' are medical services off-limits to cosmetology/esthetics licensees, reinforcing that these procedures sit under the physician-examination framework rather than a cosmetology one. Separately, New Jersey's Telemedicine and Telehealth Act (N.J.S.A. 45:1-62) expressly allows a provider to establish the provider-patient relationship remotely: the provider must review the patient's medical history/records, is held to 'the same standard of care' as an in-person encounter, and may not prescribe based solely on a static online questionnaire; only Schedule II controlled substances require an initial in-person exam, and Botox/fillers are not Schedule II, so establishing the relationship via telehealth is permitted. (A 2015 Board of Medical Examiners proposal, N.J.A.C. 13:35-6.14A/6.14B, that would have set an aesthetics/laser-specific history-exam-treatment-plan requirement was never adopted — this analysis rests on the general prescribing-exam rule and the telemedicine act, not a codified cosmetic-specific rule.) |
| New Mexico | Yes. Under the nursing aesthetic-facility rule, before a licensee provides any aesthetic healthcare procedure an APRN or other licensed independent practitioner must conduct an assessment in a face-to-face examination, determine a diagnosis, and prescribe a treatment plan — and may never delegate the examination, diagnosis, or treatment plan (16.12.14.10.B NMAC). The Medical Board's parallel rule requires the supervising physician to perform patient history, physical examination, diagnosis and a written treatment protocol before any delegated cosmetic-device procedure (16.10.13 NMAC). The aesthetic rule's express 'face-to-face examination' language indicates an in-person exam, and no NM rule authorizes telehealth to satisfy the aesthetic good-faith exam, so telehealth is treated as not sufficient here. |
| New York | New York has no separately named 'good faith exam' statute for med spas; the duty to evaluate the patient flows from the definition of the practice of medicine and professional-misconduct rules. The State Board for Medicine's energy-device guidance expressly requires 'an assessment of the patient's condition before, during, and after the procedure,' and treating or prescribing without an appropriate evaluation is misconduct under Education Law §6530. Telehealth is permitted (Public Health Law Article 29-G / §2999-cc recognizes physicians, NPs, PAs, and RNs as telehealth providers), but the same scope and standard of care apply, so an appropriate history and evaluation must precede treatment or a prescription. |
| North Carolina | Yes. The NC Board of Nursing requires that a physician, NP, PA, or other prescriber "complete client evaluation/assessment for procedure appropriateness and issue a prescription/order" before a nurse performs a cosmetic procedure, and the NC Medical Board's "Contact with Patients Before Prescribing" statement requires an appropriate history and physical examination before prescribing. Telehealth is permissible because NC holds telemedicine to the same standard of care and expressly allows a prescription in a telemedicine encounter once threshold information for a presumptive treatment plan is obtained; however, prescribing "based solely on answers to a set of questions" (online/questionnaire-only) is deemed inappropriate. |
| North Dakota | Before any aesthetic treatment, the prescriber must establish a prescriber-client relationship by performing and documenting an initial history and physical assessment and developing a client-specific plan; a general 'medical clearance' does not satisfy this, and any change to the plan or order requires a new documented H&P first. Telehealth is acceptable for the prescriber's assessment (NDCC 26.1-36-09.15(1)(g)), but photographs of a client do not constitute telehealth and are not acceptable for the assessment. |
| Ohio | Ohio has no statute or rule using the term 'good faith exam,' and the controlled-substances chapter (OAC 4731-11) does not govern neurotoxins or dermal fillers, since these are not controlled substances. The requirement to examine and evaluate a patient before administering a prescription drug such as a neurotoxin instead rests on Ohio's general unprofessional-conduct statute: ORC 4731.22(B)(2) makes 'failure to maintain minimal standards applicable to the selection or administration of drugs' a disciplinable offense, and 4731.22(B)(6) likewise disciplines 'a departure from, or the failure to conform to, minimal standards of care of similar practitioners' — together these require a physician to evaluate a patient before selecting/administering any drug, controlled or not. Telehealth is expressly permitted for this establishing evaluation: OAC 4731-37-01 states the standard of care for a telehealth visit is the same as for an in-person visit, requires a medical evaluation appropriate to the patient as part of any telehealth encounter, and allows non-controlled prescription drugs (such as neurotoxins) to be handled via telehealth simply by complying with that rule's own requirements. Only when the drug is a controlled substance does 4731-37-01 layer on the extra requirements of OAC 4731-11-09 — which is the rule that mandates an initial in-person physical exam, and only for Schedule II controlled substances. Because neurotoxins and dermal fillers are neither controlled substances nor Schedule II, that in-person-exam mandate does not reach them, and the telehealth-permissible evaluation under 4731-37-01 satisfies the standard-of-care exam requirement. |
| Oklahoma | A good-faith exam is required. Both boards' med spa guidelines require an established physician/patient relationship that includes an initial evaluation, prior to treatment, performed by the physician or by a supervised PA or supervised APRN with prescriptive authority. The evaluation may be conducted either face-to-face OR via telemedicine, so telehealth is expressly permitted (subject to the telemedicine equipment standards of OAC 435:10-7-13). |
| Oregon | Yes. The Oregon Medical Board requires a licensed provider to perform an evaluation to establish the appropriate diagnosis and treatment and obtain informed consent before treatment (medical-spa statement), and its laser statement states licensees should examine each patient prior to any initial treatment or prior to authorizing treatment. The exam may be conducted by telemedicine — the Board treats telemedicine as a delivery tool that must still include individualized review and assessment, and expressly says treatment based solely on an online questionnaire does not meet the standard of care. |
| Pennsylvania | Pennsylvania has no statute using the term 'good faith exam,' but because ordering the injectable/procedure and delegating its performance are the practice of medicine, a licensed provider (MD, DO, PA, or CRNP) must evaluate the patient, establish the diagnosis/order, and confirm the delegation 'does not create an undue risk to the particular patient being treated' before an RN or technician performs the treatment (49 Pa. Code § 18.402; Medical Practice Act § 10). No provision expressly requires the exam to be in person and Pennsylvania generally permits telemedicine, so a telehealth exam is not prohibited, but no rule squarely addresses cosmetic-procedure telehealth exams — hence the telehealth position is inferred rather than codified. |
| Rhode Island | Before any cosmetic procedure, the supervising physician, PA, or APRN must perform an initial assessment of the patient, prepare a written treatment plan (diagnoses, course of treatment, device specs), and obtain and document informed consent. RIDOH guidance stresses that standing orders do not satisfy the required provider-patient relationship and that a simple questionnaire without a genuine history and physical examination is prohibited; a practitioner may assess by telemedicine but must meet the same history-and-physical standard, and an in-person exam is preferred because a complete assessment is difficult to conduct remotely. |
| South Carolina | Before an injectable, laser, or IV treatment may be provided, a physician, PA, or APRN must personally establish a practitioner-patient relationship by performing and documenting an appropriate history and physical examination, making a diagnosis, and formulating a treatment plan (S.C. Code §40-47-113); standing orders and patient self-selection do not satisfy this duty. The evaluation need not be in person under SC's telemedicine statute (§40-47-37) if the practitioner can accurately diagnose and treat within the standard of care, but a practitioner may not establish a relationship to prescribe when an in-person physical exam is necessary for diagnosis. |
| South Dakota | There is no cosmetic-specific good-faith-exam statute, but because injectables are the practice of medicine, a valid provider-patient relationship and pre-treatment assessment are required. The SD Board of Nursing's IV and dermatological guidelines require the authorized medical provider to review the client's medical history and assess health status (or define that assessment in a written, signed protocol) before treatment is ordered and delegated. Under SDCL 34-52 the required face-to-face examination and provider-patient relationship may be established through real-time audio-visual telehealth. |
| Tennessee | Before any drug is prescribed or dispensed, the treating physician (or a supervised NP/PA under protocols) must perform an appropriate history and physical examination, make a diagnosis, and formulate a therapeutic plan; prescribing 'based solely on answers to a set of questions' is a prima facie violation for both physicians (0880-02-.14(7)) and APRNs (1000-04-.08). The exam may be conducted via telemedicine, because a valid physician-patient relationship can be established without an in-person encounter under the Board's telemedicine rule. |
| Texas | Before any nonsurgical cosmetic procedure a practitioner-patient relationship must be established and documented — a good-faith exam (history, appropriate examination, diagnosis, and written treatment plan) — by a physician, PA, or APRN. Texas permits that relationship to be established via telemedicine, including synchronous audiovisual interaction, without a prior in-person visit. |
| Utah | Utah has no statute labeled 'good faith exam,' but because injectables are prescription treatments, a licensed prescriber must establish the patient relationship and evaluate/diagnose the patient to the same standard of care as an in-person visit before treatment is ordered. That evaluation may be performed via telehealth under the Utah Telehealth Act (Title 26B/26-60) and DOPL's telehealth rule, provided the standard of care is met, identity/originating site are verified, informed consent is obtained, and the patient is seen in person when diagnosis requires a physical exam. |
| Vermont | Vermont's Medical Practice Act requires a bona fide practitioner-patient relationship before treating or prescribing: 26 V.S.A. § 1354(33) makes it unprofessional conduct to prescribe or furnish medication in response to an electronic communication without a reasonable effort to verify the patient's identity, an established documented diagnosis 'through the use of accepted medical practices,' and a current medical record. Telehealth is permitted, but the statute expressly states that 'an electronic, online, or telephonic evaluation by questionnaire is inadequate for the initial evaluation of the patient' — so a good-faith exam is required and may be conducted via telemedicine, but not by intake questionnaire alone. |
| Virginia | Before prescribing any prescription drug (including botulinum toxin and fillers), Virginia requires a bona fide practitioner-patient relationship, which includes obtaining the patient's history and performing an appropriate examination physically or by instrumentation/diagnostic equipment. That relationship may be established via telemedicine using face-to-face interactive, two-way real-time or store-and-forward technology when doing so is consistent with the standard of care, so a good-faith exam is required and telehealth is permitted. |
| Washington | Before authorizing any nonsurgical cosmetic procedure, the physician must take a patient history, perform an appropriate physical examination, make an appropriate diagnosis, recommend treatment, and obtain informed consent (WAC 246-919-606). The parallel laser rule (WAC 246-919-605) imposes the same pre-treatment history/exam/diagnosis/consent duties. The cosmetic rule does not expressly authorize a telehealth exam; Washington's general telemedicine framework permits establishing a provider-patient relationship remotely, but the rule text calls for a physical examination, so a purely remote good-faith exam for injectables is not clearly sanctioned. |
| West Virginia | West Virginia statute does not use the term 'good faith exam,' but a pre-treatment patient evaluation is functionally required: prescribing or injecting is the practice of medicine (§30-3-4), and an RN may administer treatment only 'as prescribed by' a physician or APRN (§30-7-1), so a qualifying prescriber (physician, NP, or PA) must evaluate the patient and order the treatment before it is delivered. That evaluation may be done by telehealth — §30-3-13a(c)(2) permits establishing the provider-patient relationship through real-time audio/video (or, if needed, audio-only) telemedicine, but §30-3-13a(e) provides that treatment or a prescription 'based solely on an online questionnaire does not constitute an acceptable standard of care.' |
| Wisconsin | Wisconsin has no statute using the term 'good faith exam,' but the Medical Examining Board's telemedicine rule requires a documented patient evaluation — a medical history plus, as needed to meet the standard of minimally competent practice, an examination and diagnostic tests — before a physician may issue treatment recommendations or a prescription, and expressly bars prescribing based only on a static electronic questionnaire (Med 24.07). The rule permits a physician-patient relationship to be established through telemedicine (Med 24.03), so a compliant evaluation may be done via telehealth. |
| Wyoming | Wyoming has no med-spa-specific 'good faith exam' statute, but rendering a diagnosis, a determination of medical necessity/appropriateness of treatment, and prescribing are all the practice of medicine (W.S. 33-26-102(a)(xi)(B),(E),(F)), which presupposes forming a physician-patient relationship (W.S. 33-26-102(a)(xx)) before treatment. Telemedicine is expressly recognized as the practice of medicine and the Board is authorized to regulate it (W.S. 33-26-102(a)(xxix); 33-26-202(b)(xix)), so the required evaluation/relationship may be established via telehealth; there is no promulgated rule mandating a prior in-person exam. |
Methodology & sources
Every entry is compiled from that state's own statutes, medical- and nursing-board rules, and official guidance, and each state page links the primary source behind its wording. Last reviewed 2026-07-21. Download the full dataset as CSV.
Citing this page? Use: MedSpa Standards, "Good-faith exam by State for Med Spas," retrieved 2026-07-21, https://medspastandards.com/med-spa-regulations-by-state/good-faith-exam
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This information is provided for general educational purposes only and is not legal advice. Regulations change — verify current requirements with your state medical/nursing board before acting.