The good faith exam (GFE) for med spas: who performs it, when, and how it fits your booking flow

What a good faith exam is, and why regulators care

Short answer: a GFE is the step that turns a client into a patient. It is where a prescriber decides that a medical treatment is appropriate for this person and orders it. Most state laws do not use the phrase “good faith exam”; they talk about an appropriate prior examination, a patient relationship, or an exam before delegation. The industry term covers all of them.

Here is how a few states put it:

• Texas: before a delegated nonsurgical cosmetic procedure, a physician, PA or APRN must establish a practitioner-patient relationship and create medical records (22 Tex. Admin. Code §169.26(c)).
• California: prescribing a dangerous drug “without an appropriate prior examination and a medical indication” is unprofessional conduct (Business and Professions Code §2242). Neuromodulators and fillers are prescription products.
• Washington: before authorizing a cosmetic injection or laser treatment, a physician must take a history, perform an appropriate physical examination, make a diagnosis, recommend treatment and obtain informed consent (WAC 246-919-606 and -605).
• New York: an RN may perform cosmetic injections only on a patient-specific order from a prescriber who examined the patient; NYSED has disciplined licensees for injections without those orders or without adequate examinations.

Regulators care because the exam is where contraindications are caught: pregnancy, neuromuscular disease, active infection, prior filler complications, blood thinners, photosensitizing drugs, unrealistic expectations. It is also the paper trail that shows the treatment was a medical decision rather than a retail sale.

In-person versus telehealth GFEs

Short answer: most of the large med spa states allow a telehealth exam when it meets the same standard of care as an in-person one, the patient consents and the prescriber is licensed in the state where the patient is. The weak spots are questionnaire-only models and procedure rules that call for a physical exam.

• Explicitly allowed: California’s §2242 says the prior examination may be done by telehealth; Arizona’s telehealth law (A.R.S. §36-3602) says an examination may be conducted during a telehealth encounter; Florida’s §456.47 lets a telehealth provider perform a patient evaluation.
• Allowed under a standard-of-care test: Texas, New Jersey, Ohio, Illinois, Pennsylvania, Nevada, Virginia and North Carolina all hold telehealth to the in-person standard.
• Questionnaires: the North Carolina Medical Board warns that a simple questionnaire without an appropriate evaluation may violate the law; Washington’s Medical Commission took the same position in its telemedicine guideline (verify the current policy).
• Unclear or stricter: Georgia’s telemedicine rule requires a prior in-person exam or technology equal to one; Washington’s cosmetic rules call for an “appropriate physical examination”; New York’s position on video exams for RN injection orders is not stated in the sources we found.

The full state-by-state table, with sources, is on our telehealth GFE rules by state page.

How GFEs interact with booking, deposits, memberships and marketing

Short answer: you can sell, book and promote medical aesthetic treatments online, but the purchase has to stay conditional on a prescriber saying yes. Design every flow around that.

“Book Botox online” flows

• New patients book a consultation with GFE (or a treatment slot with a GFE attached), never a bare “Botox appointment” that skips the exam.
• Intake forms collect history before the visit, but the prescriber still reviews and examines; a form is not the exam.
• If you offer telehealth GFEs, schedule them before the treatment slot and block the treatment if the GFE is incomplete or the answer is no.
• Returning patients are routed by rule: is the GFE current, and is this the same treatment?

This is also a patient-experience issue. In our study of 555 US med spas, booking and communication was the only review theme where complaints outnumbered praise (read the booking findings). A clear explanation of why a short exam comes first prevents many of those complaints.

Deposits, packages and gift cards

• Say in writing that treatment depends on the exam and that deposits are refunded if the prescriber decides the treatment is not appropriate.
• Sell packages and gift cards as credit toward services, with the same condition.
• If you offer financing, see our financing and TILA guide.

Memberships

• Signing up for a membership is a purchase; the GFE happens before the first treatment, not at checkout.
• Auto-renewal and cancellation terms have their own state laws; see the membership terms of service guide.

Ads, landing pages and texts

• Ads may promote treatments; landing pages should say an exam with a licensed provider comes first.
• Do not imply a guaranteed result or that anyone can be treated. See the off-label injectable advertising guide and FDA and endorsement rules.
• Keep tracking pixels off intake and GFE pages that collect health information; see HIPAA-safe website tracking.
• Reminder and follow-up texts need consent; see the TCPA and SMS guide for med spas.

Red flags regulators have acted on

Short answer: missing or token exams, RNs treating from standing orders, physicians who lend a license, misleading drug claims and unsafe IV services.

• No exam, no patient-specific order (New York, 2023): NYSED consent orders against an RN, an LPN and supervising licensees for “injecting Botox and/or dermal fillers into patients, without patient specific orders and/or without adequate examinations”, and for permitting an RN to do so.
• “Sponsoring physicians” (California): the Medical Board of California states there is no such thing, and that a physician working for a lay-owned business can be aiding and abetting unlicensed practice.
• Retail IV therapy (Ohio, 2025): the State Medical Board, Board of Pharmacy and Board of Nursing issued a joint statement on May 15, 2025, warning retail IV clinics that improper delegation, staffing, protocols or compounding can lead to enforcement.
• Elective IV therapy (Texas, 2025): HB 3749 (“Jenifer’s Law”), effective September 1, 2025, regulates elective IV therapy provided outside physician offices and licensed facilities.
• Misleading drug claims (FDA, 2025): a September 9, 2025 FDA warning letter to a med spa said advertising compounded semaglutide as a branded FDA-approved product misbranded the drug.
• Unsupported health claims (FTC, 2018-2019): the FTC’s action against an IV therapy marketer for claims that IV “cocktails” treated serious diseases ended in a consent order barring unsupported claims.

Each of these started with something visible: a booking page, an ad, a complaint. Marketing that matches clinical reality is part of compliance. For state advertising rules, see the guides for Texas, California, Florida and New York. For market context, see the med spa marketing statistics for 2026 and our med spa Google presence report. More guides are in the US guides library; to work with us, read how we work or book a call.

Not legal advice. This guide summarizes public rules for business planning. GFE, delegation and telehealth rules vary by state and procedure and change often. Confirm your process with your medical director, your state boards and a healthcare attorney.

Common questions

A note on this guide: it explains marketing practice, not legal advice. Rules on privacy, advertising and insurance change and vary by state, so confirm anything compliance-related with your own counsel.