Good Faith Exams in Texas: Who, When and How
The exam is what makes a treatment plan legitimate. Getting it wrong is the most common compliance gap we find.
What the exam establishes
Before a patient receives a medical aesthetic treatment, someone qualified has to evaluate them, review history and contraindications, and establish a treatment plan. That is the good faith examination. It is what converts a purchase into a course of care.
Without it, the treatment is being sold rather than prescribed, which is exactly the framing regulators use when these arrangements come apart.
How it works in practice
Who performs it
A physician, or an NP or PA operating under appropriate delegation and, where prescribing is involved, a prescriptive authority agreement.
When it is required
Before the initial course of treatment, and again when the plan materially changes: a new service, a new device, or a significant change in the patient’s history.
What gets documented
History, relevant contraindications, the assessment, and the resulting plan. The documentation is the evidence the exam happened.
Where practices get this wrong
Three patterns recur. An intake form filled out by the patient at the front desk is not an examination. An exam performed once at the first visit does not cover a service added eight months later. And an exam performed by someone without the delegated authority to perform it is not an exam at all, however thorough it was. If your practice runs high volume on injectables, this is the first thing worth auditing. If the answer is that you need the exams themselves covered rather than explained, that is what our good faith exam services for Texas med spas are for.
Audit your own process
- Who performs the exam, and what authorizes them to
- Whether it happens before treatment, every time it should
- Whether it is repeated when the treatment plan changes
- Whether the documentation would hold up if requested
Texas requirement
In Texas, only a physician licensed by the Texas Medical Board, an MD or DO, may serve as a medical director. A nurse practitioner or physician assistant cannot hold the role, though either may perform delegated services under physician supervision.
The medical director’s name and Texas Medical Board license number must be posted in all treatment areas.
Questions about good faith exams
Can it be done by telehealth?
Can an RN perform the exam?
How often does it need to be repeated?
Does a patient intake form count?
Is the exam the same thing as informed consent?
What has to end up in the patient’s file?
Key takeaways
- The exam exists because the treatment is a medical act. The Texas Medical Board has determined that nonsurgical medical cosmetic procedures are the practice of medicine.
- If it is the practice of medicine, someone with the authority to practice medicine has to decide this patient should have this treatment. That decision is the exam.
- The Board requires a physician, PA or APRN to be onsite during the procedure or immediately available for emergency consultation, and able to hold an emergency appointment if needed.
- An intake form the patient fills in at the front desk records information. It does not make a clinical decision, so it is not the exam.
Why the exam exists at all
It helps to start from why Texas expects an evaluation before treatment rather than from the phrase itself.
The Texas Medical Board states that nonsurgical medical cosmetic procedures, which it describes as including the injection of medication or substances for cosmetic purposes, the administration of colonic irrigations, and the use of a prescription medical device for cosmetic purposes, have been determined by the Board to be the practice of medicine. Those acts can be delegated by a physician to individuals who have appropriate training.
Everything else follows from that sentence. Because the treatment is a medical act, someone with the authority to practice medicine has to reach a clinical judgment that this particular patient should receive it. The exam is the name we give that judgment. It is not a formality bolted on to a cosmetic service, it is the thing that makes the service lawful to deliver.
Source: Texas Medical Board FAQ 312.
Availability is part of the same requirement
The Board pairs delegation with a presence requirement, and practices tend to treat the two as separate. They are not.
TMB states that a physician, PA or APRN must either be onsite during the procedure, or be immediately available for emergency consultation in the event of an adverse outcome, and if necessary the physician must be able to conduct an emergency appointment with the patient.
So a compliant visit has two clinical anchors, not one. Someone decided the patient should be treated, and someone qualified is reachable while the treatment happens. A practice that does the evaluation properly but cannot reach anyone at four o’clock on a Saturday has met half the standard.
What separates an exam from an intake form
This is where most of the real exposure sits, and it is usually a process problem rather than a knowledge problem.
An intake form collects history. It records allergies, medications, prior treatments and what the patient wants. All of that is useful and none of it is a decision. The exam is the point at which a qualified person reviews that information against the specific treatment proposed and concludes, on the record, that it is appropriate for this patient now.
Three things that usually go wrong
The first is timing. An evaluation done once at the first visit and never revisited stops describing the patient after the treatment plan materially changes.
The second is scope. An evaluation covering neurotoxin does not silently extend to a device treatment or an infusion added to the menu six months later.
The third is authorship. The chart should make clear who reached the judgment and what they were relying on. If the note cannot answer that, the exam is difficult to evidence afterwards even when it genuinely happened.
Sources
- Texas Medical Board FAQ 312 — nonsurgical medical cosmetic procedures, delegation and availability
- TDLR, Medspas at a Glance
- Texas Department of Licensing and Regulation, Medical Spas
- Texas Board of Nursing, Delegation FAQ
This page is general information for Texas practice owners and is not legal or medical advice. The Texas Medical Board consolidated its rules on nonsurgical medical cosmetic procedures in 2025, and requirements change. Confirm the current rule text and your own structure with the Board and with counsel before relying on this page.
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