The Med Spa Good Faith Exam: How to Run It as a System

A med spa good faith exam is the evaluation a qualified prescriber completes before a patient's first treatment, establishing the relationship and the record. Exams get missed when nothing in the schedule requires them. A Practice Diagnostic checks that system; your attorney and medical director set the requirements.

By Michael Madrinkian, MBA, PhD, Founder and Principal, Luminary Strategic

THE SHORT ANSWER

• The name varies. "Good faith exam" is a trade term. Rules and practices also call it an initial exam, an initial consult, or a physical exam. The Texas delegation rule speaks of establishing a practitioner-patient relationship.

• Clinical content belongs to your medical director. What the exam covers, and who may perform it, comes from your rules, your attorney, and your physician.

• The operating job is making it impossible to skip. That takes a trigger in the schedule, coverage on open hours, a record, and an expiry date.

• It has a cost you can plan. An exam costs something per patient however you run it, and the cheaper model depends on how much open clinician time you have.

• These are general summaries as of November 2026. They are not legal advice. Rules differ by state, so your attorney decides what applies to your practice.

WHAT THE RULES SAY ABOUT THE MED SPA GOOD FAITH EXAM

The term has no single legal definition. An American Med Spa Association article by a ByrdAdatto attorney describes it as the first encounter, before a patient's first treatment, in which a provider takes a history, performs an exam, sets a treatment plan, and confirms the patient is fit for the procedure. The same article notes that many state laws have moved to other wording.

In Texas, the Medical Board's delegation standards do not use the phrase. Under 22 Texas Administrative Code §169.26, before a delegated act is performed, a physician, or a physician assistant or advanced practice registered nurse acting under a physician's delegation, establishes a practitioner-patient relationship and completes and keeps an adequate medical record. The patient is told the identity and title of the person who will perform the act.

Section 163.1 describes the record in general: a complete, contemporaneous, and legible account of each encounter, including, to the extent applicable, the reason for the encounter, relevant history, examination findings, an assessment, and a plan of care.

Section 169.27 ties this to the written order, which includes selection criteria for screening patients. Those criteria are where the exam and the order meet: the examiner needs them in hand, and the record should show the decision.

Question for your attorney: what must our initial evaluation include, who may perform it for each service we offer, and how should it be documented?

WHERE THE SYSTEM BREAKS

In a busy practice, a med spa good faith exam rarely fails because someone decided to skip it. Exams slip through in predictable ways.

The booking has no gate. A new patient books online for a neurotoxin visit, the schedule accepts it, and the injector discovers the gap with the patient in the chair. At that point every pressure in the room favors treating.

The examiner is not available. The exam depends on someone who is off that day, in a procedure, or behind on a telehealth queue. The patient waits, or leaves.

The old exam gets stretched. A patient seen two years ago comes back for a different service. The chart holds an exam, so nobody asks whether it still covers what is planned.

The record is thin. A template with pre-filled fields produces a note that looks the same for every patient. Section 163.1 specifically asks that pre-populated fields hold current and accurate information.

Nobody measures it. Without a report, the owner learns about gaps from a chart review, a complaint, or a buyer's diligence.

SIX PARTS OF A WORKING SYSTEM

1. A trigger

Define in writing, with your medical director, which events call for an exam: a new patient, a service outside the current plan, a material change in health, and the passage of time. Then build those events into booking. The online scheduler can route new patients to a visit type that includes the exam. The front desk script asks about anything new since the last visit.

2. Coverage

Publish who performs exams in each open hour. If that person is one physician assistant or nurse practitioner, write down the backup. A coverage calendar is usually the same document that shows emergency availability, which the Texas rule also addresses; Texas med spa regulations covers it.

3. A record the examiner actually completes

The fields in the second table are a list to take to your medical director and attorney, who decide on the final form. Keep the template short enough to use, and leave findings for the examiner to write.

4. A hard stop before treatment

The injector's checklist starts with one question: is a current exam on file that covers today's service? If the answer is no, the patient goes to the examiner. Agree on this script before the first busy Saturday, and back the provider who uses it.

5. An expiry date

The Texas sections read for this post state no fixed renewal interval. The American Med Spa Association article suggests at least annually as a rule of thumb, and earlier for new treatments or health changes. Ask your medical director and attorney to set the interval, then store it as a date in your EHR so it can drive a report and a booking flag.

6. A monthly measure

Add one number to the monthly review: the share of treatment visits with a current exam on file at the time of service. Sample a handful of charts each month to confirm the notes are complete as well. Med spa KPIs covers how to build this into the owner's monthly review, and the med spa compliance binder post has a one-chart trace that starts here.

TELEHEALTH OR IN PERSON

Owners often choose between an employed or contracted examiner on site and an outside telehealth service. Texas law addresses remote care in general terms. Occupations Code §111.005 describes when a practitioner-patient relationship exists for telemedicine services, and §111.007 holds remote care to the same standard as the same service delivered in person.

Whether a telehealth exam fits a given service in your practice is a question for your attorney and medical director. The operating questions are yours:

• How long does a patient wait, and what happens to the chair while they do?

• Does the record come back into your chart, and who checks it?

• Who holds the supervision arrangement with the outside examiner, and how does it fit your medical director's agreement?

• What is the backup when the service is down?

WHAT THE EXAM COSTS: A HYPOTHETICAL

Here is a simple way to compare the two models, using round numbers that describe no real practice or vendor. Suppose a practice needs 65 exams a month: 40 new patients and 25 renewals or new-service exams.

An outside service at a hypothetical $40 per exam costs $2,600 a month. An on-site nurse practitioner at a hypothetical loaded cost of $65 an hour, spending 15 minutes per exam, costs about $16 per exam in time, or about $1,060 a month, if that time was otherwise open.

The comparison turns on that last clause. If the same 15 minutes would have gone to a treatment that earns more than the outside fee, the outside service can cost less. If the provider has open time, the on-site exam is cheaper and usually faster for the patient. Run it with your own fee, your own pay rate, and your schedule's open hours. Then add the cost nobody books: the patient who walks out because the exam took 40 minutes.

Your medical director's agreement affects this too. How much to pay a medical director covers what a practice should receive for the fee, and NP full practice authority in Texas covers the prescriptive authority agreements that often sit behind on-site exams.

WHERE THIS FITS IN A DIAGNOSTIC

Compliance operations is one of the Practice Diagnostic's four lenses. Luminary looks at whether the consent workflow, delegation records, and chart review exist and are current, and it reports gaps as questions for your attorney. The Diagnostic takes three weeks, from $5,000. Designing the workflow in depth sits in the Advisory Engagement, from $15,000.

Luminary Strategic is a firm of medical spa consultants whose principals own and operate regulated aesthetics and wellness practices. Luminary does not set clinical standards, write exam templates, or give legal advice. It takes no compensation from device makers, distributors, lenders, or software vendors, and no referral fees from attorneys, compliance vendors, or placement services. How Luminary stays independent. How Luminary approaches med spa compliance.

FREQUENTLY ASKED QUESTIONS

Can a registered nurse perform a good faith exam?

Section 169.26 names a physician, or a physician assistant or advanced practice registered nurse acting under a physician's delegation. The American Med Spa Association article describes registered nurses as able to assist while a physician, physician assistant, or advanced practice nurse reviews the findings and makes the plan. Your attorney confirms who may perform it in your state.

How long is a good faith exam good for?

The Texas sections we read state no fixed interval. The American Med Spa Association article suggests a new exam at least annually, or sooner for a treatment outside the original plan or a substantial change in health. Your medical director and attorney set the interval for your practice.

Is there a good faith exam template I can download?

Vendors and law firms offer templates, and a template can be a useful start. Your medical director should adapt it to your services and your screening criteria, and your attorney should review it. A form that fills itself in will not show that an evaluation took place.

Does every treatment need a new exam?

Generally the exam comes before the first treatment and is repeated when the plan, the patient's health, or the elapsed time calls for it. Follow-up visits under a current plan are usually handled by the treating provider. Your written order and your medical director define the specifics.

Who pays for the exam?

Practices handle this in different ways. Some build the cost into the first visit, some charge a consultation fee, and some credit the fee toward treatment. Model it as a per-patient cost either way, and have your attorney review any fee or credit language.

REQUEST A SCOPING CALL

Luminary works with med spa and wellness practice owners in person across Dallas-Fort Worth and virtually nationwide. A scoping call is 30 minutes and confirms which engagement fits. Request a scoping call or call 469-894-8793.

SOURCES

Rule summaries checked November 3, 2026. Recheck before publishing; the 90th Texas Legislature convenes January 12, 2027.

• 22 Texas Administrative Code §169.26, General Standards: https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-169-26

• 22 TAC §169.27, Physician Responsibilities Related to Written Order: https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-169-27

• 22 TAC §163.1, Medical Records: https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-163-1

• Texas Occupations Code §111.005, Practitioner-Patient Relationship for Telemedicine Medical Services: https://texas.public.law/statutes/tex._occ._code_section_111.005

• Texas Occupations Code §111.007, Standard of Care for Telemedicine, Teledentistry, and Telehealth Services: https://texas.public.law/statutes/tex._occ._code_section_111.007

• Sam Pondrom, JD (ByrdAdatto), "What Is Required of a Medical Spa's Good Faith Exams?", American Med Spa Association (May 21, 2019): https://americanmedspa.org/blog/what-is-required-of-a-medical-spas-good-faith-exams