Good faith exams by telehealth: who can perform them, and where

Ask ten med spa owners what a good faith exam is and most will describe a form. The form is not the exam. Good faith exam requirements by state are, almost everywhere, the same requirements that govern any first visit between a licensed prescriber and a new patient: a history, an assessment, a medical indication for whatever is about to be done, and a record. The phrase grew up in the aesthetics world to describe the visit a physician, nurse practitioner or physician assistant does before a nurse injects neurotoxin or filler. Now that the same businesses are adding GLP-1 weight loss, hormone panels and prescription skincare by telehealth, the exam and the telehealth new-patient visit have become the same legal object. A med spa that runs telehealth intake is already doing good faith exams at scale and should treat them as such.

What a good faith exam is

Most state statutes never use the phrase. What they contain instead is a rule that a prescriber may not prescribe, dispense or treat without first examining the patient. California's version, Business and Professions Code section 2242, says that prescribing, dispensing or furnishing dangerous drugs without an appropriate prior examination and a medical indication is unprofessional conduct. The same section says the examination does not have to be synchronous and may be conducted by telehealth, including through a self-screening tool or a questionnaire. Other states express the same idea through their definition of the patient-provider relationship or through the standard of care, and their medical boards enforce it through discipline rather than through a dedicated exam statute.

Whatever the wording, the exam has to produce five things. A history detailed enough to surface contraindications, which for a neurotoxin visit means neuromuscular disease, pregnancy, prior reactions and current medications, and for GLP-1 means personal and family thyroid history, pancreatitis, pregnancy plans and current medications. An examination appropriate to the treatment, which for injectables is a visual assessment of the treatment area and for weight loss is weight, height, the resulting body mass index and the labs the protocol calls for. A diagnosis or medical indication. An order specific to the patient. A record of all four, signed by the person who did the work.

The words "good faith" carry weight. The exam exists to decide whether the treatment is appropriate for this patient, and that decision has to be capable of coming out as a no. A visit that has never declined a patient or sent one for a lab before proceeding is a formality attached to a purchase, and a board will read it that way. The standard of care does not bend for aesthetics or for telehealth; it asks what a reasonable prescriber would have done with the same information.

Who can perform a good faith exam

A physician can perform one in every state. A nurse practitioner can perform one in every state, with a condition that varies: in states that grant nurse practitioners full practice authority, the NP examines, diagnoses and signs the order alone, while elsewhere a collaborative or supervisory agreement with a physician has to be on file before the NP's order is valid. The American Association of Nurse Practitioners maintains the current map, and the map changes most years. A physician assistant can perform one under the supervisory or collaborative arrangement the PA's state requires, and the arrangement has to name a physician who is actually reachable.

A registered nurse cannot. RNs administer under an order; they do not diagnose or prescribe, and an RN who conducts the intake, decides the patient is a candidate and injects has performed the exam without a license to do so, whatever the medical director signs later. An aesthetician cannot, and neither can a spa owner with a checklist. A medical director's review of the chart after the injection is not an exam either. The person who examines the patient has to be the person who forms the clinical judgment, before treatment, and that person has to hold a license that includes diagnosis.

Telehealth changed the economics of this for a med spa. A single physician or NP licensed in the state can perform the exam by video for several locations before the patient's appointment and produce the order the RN needs. The prescriber no longer has to be in the building. The prescriber still has to be licensed where the patient is.

Telehealth exams: where they are allowed and where a visit in person is required

States sort into patterns rather than into a clean list, and the patterns matter more than the count. The first pattern allows a new patient-provider relationship to be created by telehealth, including asynchronously through a questionnaire and store-and-forward review. California is the verified example: section 2242 says the exam need not be synchronous and may use a questionnaire. The second pattern allows telehealth for the first visit but expects a synchronous audio-video encounter to establish the relationship, and treats questionnaire-only prescribing as below the standard of care. The third pattern permits telehealth generally but carves out particular treatments, most often controlled substances and certain procedures, for which an in-person examination is required at least once.

Cutting across all three is licensure. The prescriber has to be licensed, or otherwise authorized, in the state where the patient is physically located at the time of the visit. Florida is a verified example of a state that offers a registration route: an out-of-state provider can register with the state under Rule 64B-9.008 to deliver telehealth to Florida patients without a full Florida license, subject to the conditions of that registration. A spa with locations in two states needs a prescriber authorized in both, or two prescribers.

The aesthetics-specific question is whether an exam done by video is enough when the procedure itself happens in the spa. Most boards treat the exam as the prescriber's clinical act and the injection as a delegated nursing act performed under the prescriber's order, so the exam can happen by telehealth wherever telehealth relationships are permitted. Boards do expect the prescriber to have assessed the treatment area, which for injectables means video or current photographs reviewed before the order. For GLP-1 and prescription skincare there is no in-spa procedure at all: the patient is at home, the prescriber is remote, the pharmacy ships, and the good faith exam is simply the telehealth new-patient visit by another name.

What changed in California in 2026

Several vendor posts in the med spa trade say that a California law, SB 351, took effect on January 1, 2026 and requires a good faith exam to produce a patient-specific order. The chaptered text of SB 351, read on the Legislature's own site for this post, does not say that. The bill, authored by Senator Cabaldon and approved by the Governor on October 6, 2025, adds a division to the Health and Safety Code about private equity groups and hedge funds involved with physician or dental practices. It does not mention good faith exams, telehealth, patient-specific orders or medical spas.

What SB 351 does do matters to a med spa all the same, because many spas sit inside a management services organization, the MSO that owns the brand and the business while a physician-owned professional corporation owns the clinical practice. The law bars a private equity group or hedge fund involved with a practice from interfering with clinical judgment about diagnostic tests, referrals, treatment options, patient volume or working hours, and from controlling medical records, the hiring and firing of clinical staff, payer contracts, billing and coding, or the choice of medical equipment. Non-compete and non-disparagement terms in those contracts are void, and the Attorney General can enforce. Under California's usual rule for statutes chaptered in a regular session, that applies from January 1, 2026. An investor-backed spa group whose management agreement gives the investor a say over who performs exams, how often patients are seen, or what the exam has to conclude is on the wrong side of that line.

On the exam itself, California's rule remains section 2242 as described above: an appropriate prior examination and a medical indication, with telehealth and questionnaires permitted. The patient-specific order is not a new requirement layered on top; it is the natural product of an exam that found a medical indication for a particular patient. If an operator has been told that some other California statute changed the exam rules in 2026, the right response is to ask for the section number and read it on leginfo before changing a workflow.

Standing orders versus patient-specific orders

A standing order is a written protocol from a physician that authorizes a nurse to perform a defined act for any patient who meets stated criteria, without the physician seeing that patient. A patient-specific order names the patient, the drug or device, the dose, the site or the number of units, and the date, and is signed by the prescriber who examined that patient. Both are legitimate instruments. The trouble comes from using the first where the second is required.

For prescription drugs and prescription devices used in aesthetics, which includes neurotoxins and the hyaluronic acid fillers, and for GLP-1 medications, boards expect a patient-specific order that follows an exam. A standing order that says any adult without listed contraindications may receive up to a certain number of units is, in substance, the RN making the prescribing decision, and that is the fact pattern behind most board actions involving med spas. Standing orders keep a proper place for emergency response, such as anaphylaxis protocols and the hyaluronidase protocol for a filler complication, for routine nursing tasks that involve no prescribing decision, and in some states for ordering a defined lab panel before a visit.

In a telehealth model the patient-specific order is produced automatically, because the visit ends with a prescription that travels by e-prescribing to a pharmacy, and that prescription is the order. In the in-spa model the prescriber has to write the order into the chart and tie it to the exam, and the RN's administration record has to point back to it.

Documentation that survives a board audit

Board investigators start with the chart. One that shows who examined the patient, when, by what means, what they found and what they ordered ends most inquiries at the first letter. One that shows a consent form, a photo and an invoice does not.

• Identity verification, and the patient's physical location at the time of a telehealth visit, alongside the provider's location.
• The modality used for the exam (video, telephone, or asynchronous questionnaire) and, where the modality was limited, a note on why it was adequate for the treatment ordered.
• History, including current medications, allergies, pregnancy or breastfeeding status, relevant family history and prior treatments with the same product.
• Examination findings, including current photographs of the treatment area for aesthetic procedures and the measurements the protocol calls for in weight loss or hormone therapy.
• Assessment, the medical indication, and any contraindication considered and ruled out.
• The patient-specific order: product, dose, units or sites, and any limits.
• Informed consent that names the actual product and its material risks, signed before treatment.
• The examining provider's name, license type, license number and state, with a signature and time stamp that precede the treatment.
• For delegated administration, the name and license of the person who administered, and a reference back to the order they acted on.
• The follow-up plan and the interval before re-examination, remembering that a neurotoxin exam from last year does not cover a GLP-1 start this month.

Keep the declined-patient records with the same care as the treated ones. They are the best evidence a board can see that the exam was performed in good faith.

If the exam has never once produced a no, a board will not treat it as an exam.

Questions operators ask

Can the nurse do the exam if the medical director reviews the chart later? No. Review after the fact is not an examination, and the person forming the clinical judgment before treatment has to hold a license that includes diagnosis. The medical director can perform the exam by video before the appointment, which is the arrangement most multi-location spas now use.

Can one exam cover neurotoxin and a GLP-1 start? Only if the exam actually assessed both indications, with the history and measurements each requires, and produced a separate order and a separate consent for each. One visit can do that. One visit that assessed the forehead and then added a semaglutide order cannot.

Does the exam have to be by video? It depends on the state and the product. California's statute permits an asynchronous exam by questionnaire; other states expect synchronous video for a first visit; and for injectables a visual assessment is expected everywhere.

How often does it have to be repeated? No state sets a universal clock for aesthetics. Annual re-examination plus re-examination on any material change is common practice, and every new product line is a new exam. For GLP-1 and hormone therapy the protocol and the labs set the cadence. And the prescriber has to be licensed or registered wherever the patient is during the visit, which for a telehealth patient at home may be a different state from the spa's.

Where does Tessic Health fit? Its licensed providers run the telehealth new-patient visit for the brands it operates, so a spa that adds prescription skincare or GLP-1 by telehealth gets the exam, the patient-specific order and the chart produced inside the same visit, with the pharmacy shipment following from the order. The in-spa injectable exam remains the spa's own clinical workflow under its own prescriber, and the med spa page sets out where the line between the two sits.