The short answer. A good faith exam is a clinical evaluation by a licensed provider, before treatment, establishing that the treatment is appropriate for that patient. What you are buying from a GFE vendor is not the video call — it is a defensible record that a qualified provider made a real decision. Three things determine whether it holds up: whether the person who performed it was permitted to in your state, whether an evaluation actually happened or was rubber-stamped, and whether the documentation still exists two years later when someone asks. Published per-exam prices in this market run $26.99 to $27.99; one vendor bundles the exam into $799 a month. Price is the least useful thing to compare them on.
This page is written for the person choosing a vendor. It carries who may perform the exam in thirty-three states with the statute behind each answer, what every vendor in this market publishes about price, twelve questions that separate them, and what MDside does differently. If you only want the regulatory background, the requirements article is here.
Reviewed by Victor D. Cruz, MD — founder of MDside, licensed in Florida (ME117105) and New York. Last reviewed 2026-09-03. State rows cite the statute, administrative code section, board position statement or decided case they come from. Competitor prices are quoted only where the vendor publishes them on its own site, read on 2026-09-03; where a vendor does not publish a price, this page says so rather than repeating a figure from somebody else’s ranking.
On this page: Who may perform the exam, by state · Find your state · What makes an exam defensible · What the exam must establish, by treatment · Good faith exam vs patient-specific order · What this actually costs · Twelve questions to ask any vendor · A note on the “best GFE provider” rankings · What MDside does differently · Who this is and is not for · How it works · Frequently asked questions · How this page is maintained
Who may perform the good faith exam, by state
This is the question every vendor page in this market skips. We read the good-faith-exam pages of eight GFE companies on 2026-09-02 and none of them cited a statute, an administrative code section or a board ruling anywhere. The answer is not the same in every state, and in five of the states below the difference decides whether a purely remote model, or an RN-led one, is available to you at all.
| State | Who may perform the exam | What the exam gates | Primary source |
|---|---|---|---|
| Florida | Physician exam and written order before an RN may inject. ARNP works under a written protocol. | MD/DO independent; ARNP under written protocol; PA under delegation; RN on delegation only, after a physician exam and written order. | Fla. Stat. ch. 400 pt. X; § 400.9905(4); § 464.012; ch. 458/459 |
| Texas | Physician delegation required before a delegate may treat; prescriptive authority agreements count toward the statutory cap. | Written delegation only — verbal delegation is not recognised. Physician must be immediately available. | 22 TAC 169.26; Tex. Occ. Code ch. 157; elective IV therapy law eff. 2025-09-01 |
| California | Required before treatment; the exam is a physician act that cannot be handed to a non-licensee. | Standing orders are the usual instrument, but some counsel read SB 351 to require patient-specific orders. That reading is aggressive and not settled. | Cal. SB 351 (2025); AB 1415 (OHCA pre-transaction notice) |
| New York | Physician or authorised licensee. The exam cannot be delegated to a non-licensee. | Standard delegation rules apply, and physician conduct oversight runs through OPMC and attaches to the individual. | N.Y. Educ. Law § 6530(18),(19); 8 NYCRR § 29.1(b)(4); Educ. Law art. 131 |
| Georgia | Physician exam or an APRN acting under a nurse protocol agreement. | Protocol must be reviewed annually, and the APRN must work in a comparable specialty area or field to the delegating physician. An APRN may not prescribe Schedule I or II under a protocol. | O.C.G.A. § 43-34-25 |
| Arizona | An NP with full practice authority may perform it independently. | No collaborative agreement required for an NP. The statutory duty to refer and consult outside one’s competence remains. | A.R.S. tit. 32 ch. 15; Arizona State Board of Nursing |
| New Jersey | Physician exam before RN injection; the exam is the trigger for a physician-signed protocol. | Direct supervision means immediately available on the premises, or real-time audio-video plus periodic chart review. RNs only under a detailed physician-signed protocol. Unlicensed staff never. | Allstate Ins. Co. v. Northfield Med. Ctr., N.J. Sup. Ct., 4 May 2017; N.J. Insurance Fraud Prevention Act |
| Illinois | Physician, or an FPA APRN acting independently. | Standard delegation, with the FPA carve-out removing the collaborative-agreement requirement for qualifying APRNs. | 805 ILCS 15 (Medical Corporation Act); 740 ILCS 14 (BIPA); SB 2979 (signed 2 Aug 2024) |
| Tennessee | Physician exam or an appropriately authorised licensee. | Standard delegation rules. | Tenn. Code Ann. § 63-6-105; § 63-1-153 |
| Nevada | An RN may NOT perform the good faith exam in Nevada. | An RN may inject, run IV and assist with devices only under an order. Medical assistants sit under NAC 630.830. | NRS 89.050; NRS 89.070; NRS 630.3062; NRS 630.301, 630.306; NAC 630.830 |
| Colorado | Delegating practitioner. Written informed consent must be retained for seven years. | Delegation to an RN runs through the Nurse Practice Act, not the medical board’s cosmetic delegation rule — a distinction that changes who may do what. | Colo. HB25-1024 (2025); CRS tit. 12 arts. 240, 255 |
| North Carolina | Physician or authorised licensee. | Standard delegation, read against NCMB position statements. | NCMB Position Statement 10.1.2; NCMB disciplinary commentary |
| Pennsylvania | An RN may inject only after a good faith exam by a physician, CRNP or PA. | A CRNP practises under a collaborative agreement FILED with the State Board of Medicine — filed, not merely signed and kept in a drawer. | Pa. professional corporation law; 49 Pa. Code (State Board of Medicine); collaborative agreement filing requirement |
| Ohio | Physician or authorised licensee. | Laser is the strictest in the country: the delegate must have OBSERVED 15 and PERFORMED 20 procedures per device type under direct physical oversight, and direct physical oversight means the physician in the SAME ROOM directly observing. | ORC 4731.22; ORC 4731.33; OAC ch. 4731-18 |
| Washington | Physician or authorised licensee. | Delegable to a properly trained PA, RN or LPN. The written office protocol must name the delegating physician and set out patient selection criteria and care and follow-up for common complications, serious injury and emergencies. | WAC 246-919-606; RCW 18.71; RCW 18.360 |
| Massachusetts | Physician, or an independent nurse practitioner — Massachusetts grants NPs full practice authority. | The second failure mode here is assigning procedures to staff who are not qualified for them, or a director who does not provide the oversight the role requires. | 243 CMR 2.11; McMurdo v. Getter, Mass. 1937 |
| Michigan | Physician or an authorised licensee. | MCL 333.16215 requires delegation to be genuine authorisation, matched to the individual delegatee’s education, training and experience, and paired with actual supervision. An unlicensed individual may receive delegated acts if so qualified, under supervision. | MCL 333.16215; Professional Service Corporation Act, Act 192 of 1962, § 4(3); Michigan Public Health Code |
| Virginia | Physician, PA or APRN. | Supervision must be readily available at the time treatment is given — reachable, not necessarily on site. | Va. Code § 13.1-543; § 54.1-2952; § 54.1-2957; 18VAC85-20-91; 18VAC85-50-191 |
| Maryland | Physician or an authorised licensee. | Delegation to unlicensed personnel runs through COMAR 10.32.09, with physician responsibility and training documented — and never for a surgical act. | Md. Health Occ. § 14-303(a); Board of Physicians Declaratory Ruling 00-1 (Oct 2002); COMAR 10.32.09 |
| Missouri | An RN may administer injectables and infusions only after a good faith exam by a qualified provider. | APRNs work under a written collaborative practice arrangement that reflects the services actually being delivered. LPNs are generally restricted from injectables. | RSMo ch. 356; RSMo ch. 334; Missouri collaborative practice arrangement rules |
| Minnesota | Physician or an authorised licensee. | A multi-category professional firm is permitted under § 319B.40 only where the licensing statutes authorise the combination — which is what lets an RN or APRN co-own. | Minn. Stat. ch. 319B; § 319B.40 |
| Alabama | Physician. An RN performing laser hair removal is expected to have physician presence during the procedure. | A collaborating physician must deliver 10% of a CRNP’s scheduled hours ON SITE while the CRNP is inside the two-year / 4,000-hour window; after it, meet no less than quarterly, and visit remote practice sites no less than twice a year. | Alabama collaborative practice rules (10% on-site presence; quarterly meetings; twice-yearly remote site visits) |
| Connecticut | An initial IN-PERSON assessment by that named provider. This is the clause that rules out a purely remote model for new patients. | Only licensed persons may diagnose, treat or prescribe. An RN works within scope under a valid order. | CGS § 19a-903c; CGS § 20-9; CGS § 33-182a |
| Indiana | Physician or an authorised licensee. | NP and PA within scope under the applicable arrangement; RN within scope on a valid order. | Ind. SB 282 med spa framework (most provisions 1 Jul 2026; registration 1 Jan 2027); Indiana corporate practice prohibition |
| Kansas | Physician or an authorised licensee. | KSA 65-28,127 governs licensees who direct, supervise, order, refer, accept responsibility for, enter practice protocols with, or delegate acts constituting the practice of the healing arts. | KSA 65-28,127; the licence-use subsection (b)(15); Kansas Board of Healing Arts guidance on corporations |
| Kentucky | An RN or LPN may administer an injection only when lawfully ordered by a qualified prescriber as part of a documented medical plan of care. | APRN prescriptive authority runs through a collaborative agreement until the four-year threshold for non-scheduled drugs, after which it is independent for those. APRNs may order and stock non-scheduled legend drugs for the practice. | KRS 311; KRS 314; KRS 317A; Kentucky board advisory opinions |
| Louisiana | A PRE-TREATMENT PHYSICAL EXAMINATION BY THE PHYSICIAN, with the prescriber physically present on the premises. | An RN may perform light treatments, non-ablative laser, FDA-approved neurotoxin injectables and chemical peels on a prescriber’s order with a physician or NP physically present — and is EXPRESSLY PROHIBITED from dermal fillers. | LSBME Rule § 7911; LSBME Statement of Position on the corporate practice of medicine |
| Mississippi | Physician, or an NP under an approved, filed collaborative agreement. | Quality-assurance chart review of 10% or 20 charts, whichever is fewer, per quarter, documented. The agreement must be written, signed, filed with the Board of Nursing, retained on site and available for inspection at any time. | Mississippi Board of Nursing collaborative practice rules (75-mile radius; 20 hrs/week or 80/month; quarterly QA review) |
| Oklahoma | A good faith exam before treatment. An RN may administer injectables and infusions on a valid order AFTER the exam, but may not perform the exam and may not prescribe. | Written protocols covering each delegated service. NPs participate through a collaboration or protocol arrangement and do not independently own the clinical entity. Unlicensed staff never for medical procedures. | Okla. tit. 59 §§ 492, 519.6, 567.4c; Oklahoma State Board of Medical Licensure and Supervision guidance |
| Oregon | Every med spa patient is treated as the director’s own: an evaluation establishing the diagnosis and treatment, informed consent before treatment, and proper documentation. | Diagnosis of a medical condition and development of a treatment plan are NON-DELEGABLE to anyone not licensed to provide independent medical judgment. Delegation otherwise only where the director has confirmed the staff member’s education and training. | Or. SB 951 (2025); ORS ch. 677; Oregon Medical Board guidance |
| South Carolina | The physician. Initial patient examinations are expected of the director. | NP and PA within scope under the applicable arrangement; RN within scope on a valid order. | South Carolina Board of Medical Examiners guidance and disciplinary jurisdiction |
| Utah | The supervisor, within scope. | Statutory delegation groups. Group A includes PAs under the Utah Physician Assistant Act, RNs, MASTER ESTHETICIANS and electrologists evaluating for or performing laser hair removal. Supervision must be of the person performing the procedure WHILE they perform it. | Utah Code § 58-1-505; Utah Physician Assistant Act; Medical Practice Act; Osteopathic Medical Practice Act |
| Wisconsin | Physician or an authorised licensee. A physician using telemedicine to diagnose or treat a patient located in Wisconsin must be licensed by the Medical Examining Board. | NP and PA within scope under the applicable arrangement; RN within scope on a valid order. | Wis. Stat. § 180.1901(2); Wis. Stat. § 448.03; Wis. Admin. Code ch. Med 24; Wis. Stat. ch. 766 |
| Delaware | A qualified practitioner must evaluate the patient and document the decision before treatment. Delegation is only as good as the documentation behind it. | NP under full practice authority within NP scope; PA under the applicable arrangement; RN within scope on a valid order, documented. | Del. Code tit. 8 ch. 6 (Professional Service Corporations); Del. Code tit. 24 ch. 17 (Medical Practice Act); Del. Code tit. 24 ch. 19 |
| Arkansas | ⚠️ Confirm the in-person examination requirement with the Arkansas State Medical Board BEFORE building a remote intake funnel. This is the single question that decides whether an asynchronous model works here. | APRN under the applicable collaborative arrangement; RN within scope on a valid order from a practitioner who has evaluated the patient. | Ark. Code Ann. § 17-95-201 et seq.; Arkansas State Medical Board regulations |
| Iowa | A physician evaluation and order before treatment. Iowa also regulates how the exam and the practice are ADVERTISED — the med spa rule reaches your marketing, not only your clinic. | ARNP within scope; PA under the applicable arrangement; laser work runs through the qualified laser technician framework. | Iowa Admin. Code 653—13.8; Iowa Code ch. 148; Iowa Code ch. 152 |
| Nebraska | An evaluation and order by a practitioner permitted to make that decision. The absence of a corporate practice doctrine does nothing to relax it. | NP independent within scope after the transition requirements; PA under the applicable arrangement; RN within scope on a valid order. | Neb. Rev. Stat. ch. 38 art. 20 (Medicine and Surgery); ch. 38 art. 23 (Nursing); Neb. DHHS facility licensure |
| New Mexico | A practitioner permitted to prescribe the treatment must evaluate the patient and issue the order. An RN may inject only on that order. | NP independent within NP scope; PA under the applicable arrangement; RN within scope, on an order from a practitioner who evaluated the patient. | NMSA 1978 ch. 61 art. 6 (Medical Practice Act); ch. 61 art. 3 (Nursing Practice Act) |
| New Hampshire | An evaluation and order by a practitioner permitted to make the decision, before treatment. | ⚠️ LASER use is limited to physicians and physician assistants. NP within scope otherwise; RN within scope on a valid order. | N.H. RSA ch. 329 (Medicine); RSA ch. 326-B (Nursing); 1996 repeal of the fee-splitting prohibition |
| Idaho | An evaluation and order by a practitioner permitted to make it. Idaho grants nurse practitioners full practice authority, so an NP-led model exists for services within NP scope. | NP independent within scope; PA under the applicable arrangement; RN within scope on a valid order; written protocols throughout. | Idaho Board of Medicine 2016 rescission; Idaho Code ch. 54-18 (Medical Practice Act); Idaho Code ch. 54-14 (Nursing) |
| Hawaii | Neurotoxin injections and laser treatments are MEDICAL services and must be performed by appropriately licensed professionals under the physician medical director’s supervision, following an evaluation. | NP has full practice authority for clinical purposes — but may NOT own the med spa business; PA within scope; RN within scope on a valid order. | HRS ch. 453 (Medicine and Surgery); HRS ch. 457 (Nursing) |
| Rhode Island | An evaluation and order by the medical director or another practitioner permitted to make it, before treatment. | ⚠️ Licensed practical nurses, nursing assistants and MEDICAL ASSISTANTS may not provide services — it falls outside their scopes. RN within scope on a valid order. | R.I. Medical Spas Safety Act; R.I. Dept. of Health guidance for medical spa and IV therapy businesses; R.I. Gen. Laws ch. 5-37 |
| West Virginia | A good faith examination and treatment plan before treatment, by a qualified practitioner, under signed protocols. | NP and PA within scope under the applicable arrangement; RN within scope on a valid order; delegation only to practitioners whose licence and training support the task. | W. Va. Code § 30-3-15; W. Va. Code ch. 30 art. 3; W. Va. Code ch. 30 art. 7 |
| Maine | A qualified practitioner must evaluate and authorise treatment. Ownership confers NO authority to perform or to order. | ⚠️ Maine grants NPs full practice authority only AFTER a supervised transition period — before that, a physician relationship is required, and the answer is INDIVIDUAL-SPECIFIC. | Me. Rev. Stat. tit. 32 ch. 48 (Medicine); tit. 32 ch. 31 (Nursing); Maine State Board of Nursing transition-to-practice requirements |
| Montana | An evaluation and order by a practitioner permitted to make it, before treatment. | NP has full practice authority within NP scope; PA under the applicable arrangement; RN within scope on a valid order. | Mont. Code Ann. tit. 37 ch. 3 (Medicine); tit. 37 ch. 8 (Nursing) |
| Alaska | An evaluation and order by a practitioner permitted to make it. ⚠️ Alaska’s Division convened a Medical Spa Services Work Group and published a DRAFT interdisciplinary scope matrix — who may perform what is still being mapped. | Conservative delegation only, to practitioners whose own licence clearly supports the task, under written protocols. Silence in an unsettled state is not permission. | AS 10.45.020; AS 10.45.030; AS 08.64 (State Medical Board); Alaska Div. of Corporations, Business and Professional Licensing, Medical Spa Services Work Group |
| District of Columbia | An evaluation and order by a practitioner permitted to make it, before treatment. The entity rule says nothing about how the care is supervised — that is a separate obligation. | NP and PA within scope under the applicable arrangement; RN within scope on a valid order. | DC Code § 29-508(a), (b), (c); DC Code tit. 3 ch. 12 (Health Occupations) |
| North Dakota | ⚠️ § 43-17-02.3: the practice of medicine is DEEMED TO OCCUR IN THE STATE THE PATIENT IS LOCATED. Whoever performs the exam needs an ACTIVE North Dakota licence, wherever they sit. | NP and PA within scope under the applicable nursing and medical rules; RN within scope on a valid order. | N.D.C.C. § 43-17-02.3; N.D.C.C. § 43-17-31; N.D.C.C. ch. 43-12.1 (Nursing) |
| Puerto Rico | An evaluation by a practitioner licensed by the Junta. ⚠️ Ley 8-2025 (approved 11 April 2025) removed the separate telemedicine CERTIFICATION for professionals already authorized to practise in Puerto Rico — practitioners licensed only in a mainland or federal jurisdiction still need it. | Within scope under the applicable Puerto Rico rules; RN within scope on a valid order. | Ley 139-2008 (Junta de Licenciamiento y Disciplina Médica); Ley 168-2018 (Telemedicina), as amended by Ley 8-2025 |
| South Dakota | An evaluation and order by a practitioner permitted to make it. ⚠️ SDCL 36-4-8.2: use of a LASER or ionizing radiation to cut “or otherwise alter” human tissue IS SURGERY constituting the practice of medicine. | Delegation only to a practitioner whose licence and training support performing a surgical act, under written protocols naming device, settings, indications and contraindications. | SDCL 36-4-8.1; SDCL 36-4-8.2; SDCL 47-11-1; SDCL 47-11-2; SDCL 47-11-3 |
| Vermont | An evaluation and order by a practitioner permitted to make it. § 9772’s stated purpose is to keep clinical and treatment decisions EXCLUSIVELY in the hands of health care providers. | NP independent within scope; PA under the applicable arrangement; RN within scope on a valid order. | Vt. H.583 (2026), § 9772, § 9773; 26 V.S.A. ch. 23 (Medicine) |
| Wyoming | An evaluation and order by a practitioner permitted to make it. Services may be rendered only by and through licensed stockholders OR LICENSED EMPLOYEES — the treating clinicians need not be owners. | NP and PA within scope under the applicable arrangement; RN within scope on a valid order; written protocols throughout. | W.S. 17-3-101; W.S. tit. 33 ch. 26 (Medical Practice Act); W.S. tit. 33 ch. 21 (Nursing) |
Five rows are worth reading twice. Nevada and Oklahoma: an RN may not perform the exam at all — they may inject only under an order, after somebody else has performed it. Louisiana: the pre-treatment physical examination is the physician’s, with the prescriber physically present on the premises, and an RN may not inject dermal filler at any time. Connecticut: the initial assessment must be in person, which rules out a purely remote model for new patients — the single most important sentence on this page for anyone buying telehealth exams. Pennsylvania: an RN may inject only after an exam by a physician, CRNP or PA, and the CRNP’s collaborative agreement has to be filed with the State Board of Medicine, not merely signed. Florida: an RN needs a physician exam and a written order before injecting. A vendor that staffs exclusively with nurse practitioners has a different answer available to it in those states than a physician network does. Verified against the cited sources on 2026-09-03.
Find your state
All fifty states plus the District of Columbia and Puerto Rico — every one of them now carries verified, statute-level guidance rather than a paraphrase of somebody else’s summary. Each row links to that jurisdiction’s own good faith exam page. Type to filter.
| Jurisdiction | Who may perform the exam | State page |
|---|---|---|
| Alabama | Physician. An RN performing laser hair removal is expected to have physician presence during the procedure. | Open |
| Alaska | An evaluation and order by a practitioner permitted to make it. ⚠️ Alaska’s Division convened a Medical Spa Services Work Group and published a DRAFT interdisciplinary scope matrix — who may perform what is still being mapped. | Open |
| Arizona | An NP with full practice authority may perform it independently. | Open |
| Arkansas | ⚠️ Confirm the in-person examination requirement with the Arkansas State Medical Board BEFORE building a remote intake funnel. This is the single question that decides whether an asynchronous model works here. | Open |
| California | Required before treatment; the exam is a physician act that cannot be handed to a non-licensee. | Open |
| Colorado | Delegating practitioner. Written informed consent must be retained for seven years. | Open |
| Connecticut | An initial IN-PERSON assessment by that named provider. This is the clause that rules out a purely remote model for new patients. | Open |
| Delaware | A qualified practitioner must evaluate the patient and document the decision before treatment. Delegation is only as good as the documentation behind it. | Open |
| District of Columbia | An evaluation and order by a practitioner permitted to make it, before treatment. The entity rule says nothing about how the care is supervised — that is a separate obligation. | Open |
| Florida | Physician exam and written order before an RN may inject. ARNP works under a written protocol. | Open |
| Georgia | Physician exam or an APRN acting under a nurse protocol agreement. | Open |
| Hawaii | Neurotoxin injections and laser treatments are MEDICAL services and must be performed by appropriately licensed professionals under the physician medical director’s supervision, following an evaluation. | Open |
| Idaho | An evaluation and order by a practitioner permitted to make it. Idaho grants nurse practitioners full practice authority, so an NP-led model exists for services within NP scope. | Open |
| Illinois | Physician, or an FPA APRN acting independently. | Open |
| Indiana | Physician or an authorised licensee. | Open |
| Iowa | A physician evaluation and order before treatment. Iowa also regulates how the exam and the practice are ADVERTISED — the med spa rule reaches your marketing, not only your clinic. | Open |
| Kansas | Physician or an authorised licensee. | Open |
| Kentucky | An RN or LPN may administer an injection only when lawfully ordered by a qualified prescriber as part of a documented medical plan of care. | Open |
| Louisiana | A PRE-TREATMENT PHYSICAL EXAMINATION BY THE PHYSICIAN, with the prescriber physically present on the premises. | Open |
| Maine | A qualified practitioner must evaluate and authorise treatment. Ownership confers NO authority to perform or to order. | Open |
| Maryland | Physician or an authorised licensee. | Open |
| Massachusetts | Physician, or an independent nurse practitioner — Massachusetts grants NPs full practice authority. | Open |
| Michigan | Physician or an authorised licensee. | Open |
| Minnesota | Physician or an authorised licensee. | Open |
| Mississippi | Physician, or an NP under an approved, filed collaborative agreement. | Open |
| Missouri | An RN may administer injectables and infusions only after a good faith exam by a qualified provider. | Open |
| Montana | An evaluation and order by a practitioner permitted to make it, before treatment. | Open |
| Nebraska | An evaluation and order by a practitioner permitted to make that decision. The absence of a corporate practice doctrine does nothing to relax it. | Open |
| Nevada | An RN may NOT perform the good faith exam in Nevada. | Open |
| New Hampshire | An evaluation and order by a practitioner permitted to make the decision, before treatment. | Open |
| New Jersey | Physician exam before RN injection; the exam is the trigger for a physician-signed protocol. | Open |
| New Mexico | A practitioner permitted to prescribe the treatment must evaluate the patient and issue the order. An RN may inject only on that order. | Open |
| New York | Physician or authorised licensee. The exam cannot be delegated to a non-licensee. | Open |
| North Carolina | Physician or authorised licensee. | Open |
| North Dakota | ⚠️ § 43-17-02.3: the practice of medicine is DEEMED TO OCCUR IN THE STATE THE PATIENT IS LOCATED. Whoever performs the exam needs an ACTIVE North Dakota licence, wherever they sit. | Open |
| Ohio | Physician or authorised licensee. | Open |
| Oklahoma | A good faith exam before treatment. An RN may administer injectables and infusions on a valid order AFTER the exam, but may not perform the exam and may not prescribe. | Open |
| Oregon | Every med spa patient is treated as the director’s own: an evaluation establishing the diagnosis and treatment, informed consent before treatment, and proper documentation. | Open |
| Pennsylvania | An RN may inject only after a good faith exam by a physician, CRNP or PA. | Open |
| Puerto Rico | An evaluation by a practitioner licensed by the Junta. ⚠️ Ley 8-2025 (approved 11 April 2025) removed the separate telemedicine CERTIFICATION for professionals already authorized to practise in Puerto Rico — practitioners licensed only in a mainland or federal jurisdiction still need it. | Open |
| Rhode Island | An evaluation and order by the medical director or another practitioner permitted to make it, before treatment. | Open |
| South Carolina | The physician. Initial patient examinations are expected of the director. | Open |
| South Dakota | An evaluation and order by a practitioner permitted to make it. ⚠️ SDCL 36-4-8.2: use of a LASER or ionizing radiation to cut “or otherwise alter” human tissue IS SURGERY constituting the practice of medicine. | Open |
| Tennessee | Physician exam or an appropriately authorised licensee. | Open |
| Texas | Physician delegation required before a delegate may treat; prescriptive authority agreements count toward the statutory cap. | Open |
| Utah | The supervisor, within scope. | Open |
| Vermont | An evaluation and order by a practitioner permitted to make it. § 9772’s stated purpose is to keep clinical and treatment decisions EXCLUSIVELY in the hands of health care providers. | Open |
| Virginia | Physician, PA or APRN. | Open |
| Washington | Physician or authorised licensee. | Open |
| West Virginia | A good faith examination and treatment plan before treatment, by a qualified practitioner, under signed protocols. | Open |
| Wisconsin | Physician or an authorised licensee. A physician using telemedicine to diagnose or treat a patient located in Wisconsin must be licensed by the Medical Examining Board. | Open |
| Wyoming | An evaluation and order by a practitioner permitted to make it. Services may be rendered only by and through licensed stockholders OR LICENSED EMPLOYEES — the treating clinicians need not be owners. | Open |
No jurisdiction matches that. Show all 52.
What makes an exam defensible
Nobody is ever asked to produce a good faith exam on a good day. The question arrives after an adverse event, a board complaint, an insurance dispute or a records request, and it is always the same question: show me that a qualified provider evaluated this patient before you treated them. Five things decide the answer.
- The provider was permitted to perform it in that state. Not “licensed somewhere” — licensed there, and holding a licence type the state allows for that act. Nevada excludes RNs from performing the exam outright.
- An evaluation actually happened. A history, a relevant examination, a clinical judgement, and a treatment decision that could have come out the other way. A workflow that cannot produce a “no” is not producing an evaluation, whatever it produces on screen.
- The record shows the reasoning, not just the outcome. “Approved” is an outcome. What was reviewed, what was considered, what was ruled out and why this treatment for this patient is a record.
- The scope of what was cleared matches what was done. An exam that cleared a neuromodulator does not cover the GLP-1 someone added at the counter. Vendors that advertise clearing a large number of treatments in one screening are describing convenience; the scope still has to match the chart.
- The record is still retrievable later. Two years later, after you changed vendors. Colorado requires informed consent retained for seven years. If the documentation lives only in a vendor’s portal, ask what happens to it when you leave.
What the exam has to establish, by treatment
Vendors advertise treatment counts — “over 150 treatments”, “170+”, “up to 11 in a single screening”. A count tells you what a platform will let a provider clear. It does not tell you what the provider has to satisfy themselves of before clearing it, and that is different for every category below. This is the table we work from.
| Category | What the exam has to establish | Where it goes wrong | More |
|---|---|---|---|
| Neuromodulators and fillers | Indication, injection-site anatomy and history, contraindications, and that the person who will inject is permitted to in that state after this exam. | An exam performed generically and then used to cover a different product, a different area or a different injector. | Aesthetics and injectables |
| Lasers and energy devices | Device-specific suitability, skin type, photosensitising medication, and the operator’s authority for that device class. | Ohio requires the delegate to have observed 15 and performed 20 procedures per device type, with the physician in the same room, and prohibits delegating ablative procedures at all. | The Ohio numbers |
| IV therapy and hydration | That an infusion is clinically indicated for this patient, the order behind it, and who may start the line. | Washington lets a certified medical assistant establish a line but not administer medication, and only gives IV injections under direct visual supervision. Nevada bars an RN from performing the exam itself. | IV therapy |
| NAD+ infusions | The same as any infusion, plus honesty about what is being claimed for it. | Claims outrunning evidence is the enforcement risk here more than the infusion is. | NAD claims |
| Weight management and GLP-1s | Indication, comorbidities, contraindications, a monitoring plan, and the regulatory status of the specific product being dispensed. | Routine programme-wide compounded semaglutide or tirzepatide, now that the shortage basis has ended. Retatrutide has no lawful compounding pathway at all. | After the shortage |
| Hormone therapy and TRT | Symptoms, labs where indicated, risk discussion against the current labelling, and the DEA framework where testosterone is involved. | The February 2026 label changes removed several boxed warnings but the endometrial cancer warning remains for systemic estrogen-only products, and none of it reaches compounded preparations. | The label change |
| Peptides | That the specific peptide has a lawful compounding pathway before anything else is discussed. | Treating absence from a prohibited list as permission. BPC-157 sits in regulatory limbo, and limbo is not a green light. | Peptide status |
| PRP and microneedling | Suitability, and the sterility and handling chain around the preparation. | The real risk in this category is contamination, not the injection. | Infection control |
| Exosomes and stem-cell products | Whether the product may lawfully be administered at all. | These are unapproved biologics. The exam cannot make an unlawful product lawful, and the marketing around them is its own exposure. | Unapproved biologics |
The pattern across the table: for aesthetics the hard question is usually who may perform it; for prescription programmes it is usually whether the product itself is lawful. A vendor that answers only the first has solved half of your problem. Approved, cleared, registered and compounded are four different things.
Good faith exam versus patient-specific order
Two of the largest vendors in this market publish a page on this distinction, which tells you how often it is got wrong. They are not interchangeable and they do different jobs.
| Good faith exam | Patient-specific order | |
|---|---|---|
| What it is | A clinical evaluation establishing that a treatment is appropriate for this patient. | A direction from an authorised prescriber to administer a specific treatment to a named patient. |
| What it produces | A documented clinical judgement, with reasoning. | An authorisation to act, referencing the evaluation behind it. |
| Who can do it | A provider the state permits to evaluate — which in several states excludes RNs. | A prescriber acting within their own authority and, where required, a written protocol. |
| What it does not do | It does not, by itself, authorise a specific drug or dose. | It does not substitute for the evaluation. An order written without one is the exposure. |
| Where operators go wrong | Treating it as a form to be completed rather than a decision that can go either way. | Standing orders used where the state expects patient-specific direction — an open question under California SB 351. |
Read them together: the exam is the reasoning, the order is the instruction, and a chart needs both to make sense. The longer treatment of what the documentation has to show.
What this actually costs
Every figure below is published by the vendor on its own site and was read on 2026-09-03. Where a vendor does not publish a price, this table says so — we have not filled the gap with a number from somebody else’s ranking, because those numbers are not verifiable and the rankings have an interest in them.
| Vendor | Published price | Model | What they say it includes |
|---|---|---|---|
| Qualiphy | $27.99 per exam | Pay as you go. “No Sign Up Fee… No Subscription Fee… Cancel Anytime.” | Instant consultations, telemedicine integration, off-hours support, customisable questionnaires. |
| GoodFaithExams.com | $26.99 per exam | “No subscriptions. No contracts. No minimums.” | Intake, licensed provider evaluation, clinical decision documentation, record-keeping. Explicitly excludes automatic approvals without evaluation. |
| Medical Director Co. | $799 per month | Flat monthly, no setup fee, no per-encounter charge. | Exam coverage plus an attorney-reviewed physician agreement, a state-matched delegation agreement, ongoing chart review and access to the assigned physician. |
| Spakinect | Not published | Membership, with a 30-day trial advertised. | Membership framing, EMR integrations, and partner savings. The fee itself is behind a conversation. |
| WeTreat | Not published | Consultation-gated. | Bundled with medical direction, marketing and launch services. |
| Docovia / GFEase | Not published | “Flat rate per exam”, advertised with no setup, monthly or per-location fee. | Virtual good faith evaluations. |
| The market, as one vendor describes it | $27–$40 per encounter | Medical Director Co.’s own published range for per-exam vendors; it puts in-house exams at $30–$45. | Quoted here because it is the only published range in the market, by a party arguing against the model. |
What the per-exam number hides. Three exams at $27 are cheaper than a monthly fee and three hundred are not, so volume decides the model before quality does. More importantly, the price does not tell you the licence type on the other end, whether the fee buys a physician or a nurse practitioner, whether anyone reviews the chart afterwards, whether protocols come with it, or what happens to your records when you leave. A cheap exam that a board does not accept is not cheap. Ask the twelve questions below before comparing prices.
How MDside prices it. Fixed and agreed in writing before services begin, sized to your menu and footprint rather than to your revenue — the same constraint that governs our directorship fees, because several states prohibit paying a management company a share of clinical revenue and New York prohibits it outright. Why the fee has to be structured that way, and how pricing works in detail.
Twelve questions to ask any GFE vendor
Including us. These are the questions whose answers actually differ between vendors, and most of them are not answerable from a pricing page. Score every vendor on the same twelve and the field sorts itself out quickly.
- What licence type performs my exams — MD, DO, NP or PA? And is it the same answer in every state I operate in? Several networks are nurse-practitioner-only, which is fine in some states and not available in others.
- Are your providers employed or contracted? Employment is not a compliance requirement, but it changes supervision, continuity and who answers when something goes wrong.
- Can your workflow produce a “no”? Ask what percentage of exams do not result in clearance, and what happens on screen when a patient should not be treated. A system that cannot decline is not evaluating.
- Who signs, and what does the signed record contain? Ask to see a sample. The reasoning should be legible to someone who was not there.
- Can I export my records, and what happens to them if I leave?
- Do you write protocols against my actual menu, or supply a template? A template with a state name pasted on top is the most common product in this market.
- Who reviews charts after the fact, and how often? The exam is the front end; chart review is what a board asks about.
- What happens when the law changes in one of my states? Ask them to name a change from the last eighteen months and what they did about it.
- Is a medical director included, and does that physician do the work? An exam vendor and a directorship are different products; some bundle them loosely and the bundle is where accountability disappears.
- What is your position on compounded GLP-1s and on retatrutide? A vendor without a clear answer in 2026 has not read the enforcement history.
- How is the fee structured — and would that structure be lawful in New York? Percentage-of-revenue arrangements are prohibited there. A vendor that has not thought about it has not thought about multi-state.
- What is the escalation path during treatment hours? Not a support inbox — the clinical one, when a patient in your chair needs a decision.
A note on the “best GFE provider” rankings
“We evaluated 18 GFE telehealth providers and ranked the top seven.”
The most widely circulated “best good faith exam companies” ranking in this market is published by one of the companies it ranks, and that company places itself first with the highest composite score. The methodology is unusually transparent — seven weighted criteria, scores out of ten, a stated research window — and the conflict is not disclosed anywhere on the page. Read on 2026-09-03. There is a second pattern worth knowing: a separate site publishes “Top 10 good faith exam providers in <state>” pages across many states, which is listicle SEO rather than evaluation. We are not going to publish a ranking that puts MDside first. The twelve questions above are the scorecard — use them on us too.
What MDside does differently
- Physicians, not only nurse practitioners. MDside supplies MDs and DOs. NPs, PAs and RNs are your staff, working within their own licences under protocols an MDside physician approves. In the states in the table above where an RN may not perform the exam, that difference is the whole answer. Why the licence type matters.
- No automatic approvals, ever. Every approval is a decision a licensed provider made and signed. There is no auto-clear path in our platform, by design — because the first question after an adverse event is whether anybody actually looked.
- Per-ingredient decision support. The reviewing provider sees each ingredient in the requested treatment scored against the patient’s intake before deciding. It is decision support; the physician still decides and still signs.
- A signed record with an audit trail. The exam produces a signed PDF and a timestamped log of who did what and when. How we handle patient data.
- E-prescribing and fulfilment behind the exam. Where a prescription follows, it routes to 503A or 503B pharmacies, with lab draws where the protocol calls for them.
- The structure underneath it. An exam sitting on top of an entity that cannot lawfully hold the practice does not survive review. Medical direction, the professional entity and management agreement, and the exam are one product here, not three vendors. Medical director requirements in all 52 jurisdictions.
- Reactive intake. Patients answer the questions relevant to what they are actually asking for, and the full set when the product is unrecognised. Shorter for the patient, and the fail-safe direction is toward more information, not less.
- Published, cited state guidance. The table above, and a page per jurisdiction. LegitScript certified; how we credential providers; our clinical standards.
Who this is and is not for
Borrowed straight from a competitor who does this well, because it saves everybody time.
- A good fit: med spas and aesthetic clinics adding injectables, lasers or weight management; IV and wellness clinics; gyms and recovery studios adding a prescription programme; online and DTC brands that need licensed providers in every state they ship into; pharmacies and labs that need an ordering provider.
- A good fit: operators in more than one state, where the answer changes at the border and one vendor policy will not cover it.
- Not a fit: anyone looking for a signature without an evaluation. We do not sell that and it is the thing that gets people disciplined.
- Not a fit: programmes built on retatrutide, which has no lawful compounding pathway, or on routine programme-wide compounded GLP-1s now that the shortage-era basis has ended.
- Not a fit today: async prescribing of controlled substances in states that require otherwise — and note the DEA telemedicine flexibilities expire 31 December 2026, which is a live problem for telehealth TRT.
- Not legal advice. We build and operate the clinical side; your counsel reviews it. Any vendor telling you their product removes the need for counsel is selling you something else.
How it works
- State and menu review. You tell us what you sell and where. We tell you who may perform the exam in each of those states, what your current process fails, and whether you need a directorship as well as exams. Free, and you are not obliged to use us for the fix.
- Protocols and structure. Protocols and standing orders written against your real menu, delegation documented in the form your state recognises, and the professional entity and agreements where those are needed.
- Intake and routing. Reactive intake configured to your menu, connected to your existing scheduling where that makes sense, so the patient answers what is relevant and the provider sees what matters.
- Exams, review and fulfilment. A licensed provider evaluates, decides and signs. Where a prescription follows it routes to the pharmacy; where labs are indicated they are ordered. Charts are reviewed on a documented cadence, and the paperwork is updated when the law moves.
By service line
Unfamiliar terms? The glossary defines good faith exam, standing order, delegation, fee splitting, 503A versus 503B and FDA approved as regulators use them.
Frequently asked questions
What is a good faith exam?
A clinical evaluation by a licensed provider, before treatment, establishing that the treatment is appropriate for that patient. It is a real encounter with a real decision in it, not a consent form and not a questionnaire. The long version.
Who can perform a good faith exam?
It depends on the state. In Nevada and Oklahoma an RN may not perform it at all. In Louisiana it is the physician’s examination and the prescriber has to be physically on the premises. In Connecticut the initial assessment has to be in person. In Pennsylvania an RN may inject only after an exam by a physician, CRNP or PA. The thirty-three-state table is above.
Can a nurse practitioner perform it?
In many states yes, and in some states an NP with full practice authority can act independently — Arizona and Illinois are the clearest. That is different from an NP being able to hold the medical-director role, which most states do not permit. The comparison.
Can the exam be done by telehealth?
In many states, yes, subject to the state’s telehealth rules and to the standard of care for the specific treatment. It is a real clinical encounter conducted remotely, not a lighter version of one. Where a controlled substance is involved the DEA rules apply on top, and those expire on 31 December 2026.
How much should a good faith exam cost?
Published per-exam prices in this market are $26.99 and $27.99; one vendor publishes a $27–$40 range for the category and bundles exams into $799 a month instead. Several vendors do not publish a price at all. The table is above. Volume decides which model is cheaper long before quality does.
How often does a patient need a new exam?
Vendors commonly work to at least every six months, or sooner when the health history changes or the treatment plan changes materially. Treat that as a floor rather than a rule: the question is whether the evaluation on file still supports what you are about to do today.
Does one exam cover every treatment on the menu?
No. Some vendors advertise clearing a large number of treatments in a single screening, and that can be genuinely efficient, but the scope cleared still has to match what was actually performed. An exam that cleared a neuromodulator does not cover a GLP-1 added at the counter.
What happens if the patient should not be treated?
The provider declines, documents why, and where appropriate refers. Ask any vendor what proportion of exams do not result in clearance. A workflow with no path to a “no” is not an evaluation, and that is the finding a board makes afterwards.
Who is liable if the exam was not properly performed?
Exposure lands on the licensee whose judgement was supposedly exercised, on the practice, and in some circumstances on the people who built the arrangement — New Jersey’s Allstate v. Northfield reached the parties who promoted the structure. That case.
Do I still need a medical director if I buy exams from a vendor?
Usually yes, and they are different products. The exam clears a patient; the director approves protocols, delegates, supervises, reviews charts and answers for the clinical operation. Requirements by state.
Can I use my own physician and just license the platform?
Yes. Some clients bring their own director and use us for exams, intake and documentation; others take the whole stack. The state review at the start tells you which you actually need.
Do you integrate with my scheduling or EMR?
We connect to existing intake and scheduling where it makes sense rather than asking you to abandon what your front desk already uses. Bring your stack to the state review and we will tell you honestly what connects and what does not.
Who owns the records?
You should, and you should confirm that with every vendor you consider, in writing, before you start — including the export path when the relationship ends. Colorado requires informed consent retained for seven years; a portal you have lost access to does not satisfy that.
Is a good faith exam the same as a patient-specific order?
No. The exam is the evaluation and the reasoning; the order is the instruction to administer. A chart usually needs both. The comparison is above.
Can unlicensed staff perform any part of this?
They can collect intake. They cannot perform the evaluation, and in several states they cannot perform the treatment either — Colorado requires signage naming the delegating practitioner where unlicensed individuals perform delegated aesthetic services, and Ohio prohibits delegating ablative light-based procedures at all.
Do you provide exams for weight management and GLP-1 programmes?
Yes, within a defensible clinical basis. The shortage-era compounding model has ended: tirzepatide came off the shortage list in October 2024, semaglutide in February 2025, and enforcement discretion ended in April and May 2025. What that changed. We do not prescribe retatrutide.
Do you cover hormone therapy and TRT?
Hormone therapy yes. Testosterone is Schedule III, so telehealth TRT sits inside the DEA framework and the current flexibilities expire on 31 December 2026. Any vendor selling you an async TRT programme without raising that has not read it.
How fast is the exam?
Vendors compete hard on connection time and some publish figures in seconds. We are not going to quote a number we have not measured and published a method for. Speed is worth having and it is the wrong thing to optimise first — the exam has to be able to take longer when the patient warrants it.
What states do you cover?
All fifty, plus the District of Columbia and Puerto Rico — and every one of them now has its own good faith exam page with statute-level guidance, not a paraphrase. The finder is above.
We already use another GFE vendor. Can you review what we have?
Yes, and that is the most useful thing we do first. Bring a sample signed exam, your protocols and your delegation documentation and we will read them against the five tests above and the state you operate in. Book the review — free, and you are not obliged to switch.
Is any of this legal advice?
No. It is a working reference maintained by an operator, with the primary source cited so you can check it. Confirm your obligations with healthcare counsel licensed where you operate.
How this page is maintained
State rows are verified against statute, administrative code, a board position statement or a decided case — never against another company’s blog. Competitor prices and claims are read directly from each vendor’s own site and dated; where a vendor publishes no price we say so instead of repeating a figure from a ranking with an interest in it. Where a state has not settled a question — Arkansas’s in-person examination requirement, Alaska’s med spa scope matrix — the page says so rather than inventing a clean answer. Last reviewed 2026-09-03 by Victor D. Cruz, MD. Corrections are welcome and get made: contact us.
Want your current exam process read against the five tests, in the states you actually operate in? Book a call — the state and menu review is free, and you are not obliged to use us for the fix.
General information about good faith exams and practice structure, not legal advice. Requirements differ by state and change often. Competitor pricing and claims described here were read on each vendor’s own website on the review date above and may have changed. Confirm your obligations with healthcare counsel licensed where you operate.