What a Good Faith Exam Actually Requires (and What It Should Cost You)

If you run your own aesthetics, wellness, or functional health practice, you already know the Good Faith Exam is the gate every treatment has to pass through. What's changed over the last two years is how seriously state boards are checking whether that gate actually exists.

Here's the short version of the requirement. A Good Faith Exam is a real medical evaluation that happens before treatment. The provider reviews the patient's history, screens for contraindications, makes a diagnosis, and authorizes the treatment plan. That evaluation is the practice of medicine, which means an RN can't perform it independently in any state. Depending on where you practice, it takes an MD, DO, NP, or PA. Most states accept a synchronous video visit with full documentation, typically renewed annually.

That's what's on paper. Enforcement is where 2025 and 2026 got interesting.

Texas passed HB 3749 after a patient death at a Wortham med spa, and as of September 1, 2025, elective IV therapy can only be ordered by a physician, or by a PA or APRN under physician delegation with a documented prescriptive authority agreement behind it. New York ran a joint city and state investigation that inspected 15 med spas and opened disciplinary proceedings against all 15, and every adjudicated case so far has ended in license revocation. Arkansas's nursing board published written guidance clarifying that exams weren't being conducted properly across the state. And multiple boards have disciplined RNs for administering GLP-1 injections where no prescriber ever assessed the patient.

The pattern is the same across every one of those actions: a busy practice running an informal or outdated workflow. Usually that means an intake form standing in for an exam, or a director who signs charts once a quarter, or a "we'll document it later" habit that worked fine until an inspector asked for the charts.

So what does a compliant workflow actually look like?

The exam has to happen before treatment, every single time, performed by a qualified provider, and it has to be synchronous if your state requires that. Documentation is the part practices get wrong most often. It needs to land in the patient's chart with the provider's name, license, and signature attached, not sit in a separate inbox you'd have to dig through during an audit. Then it gets renewed on whatever schedule your state expects.

None of that is complicated. It's just relentless, which is why cost matters more than it looks like it should.

The cost question

A workflow that's too expensive quietly stops happening on busy days. Nobody decides to skip exams. It just becomes the thing that slides when the schedule is full and every exam has a price tag on it.

On-demand GFE services across the market run $27 to $28 per exam. At 30 exams a month, that's over $800 before you've paid your medical director a dollar. If you run event days, walk-ins, or steady IV volume alongside aesthetics, your number is higher than you think.

Five Square members get on-demand Good Faith Exams for $19.99, seven days a week including holidays, with results delivered straight into the patient chart. We subsidize that price for our members because we believe in nurse success. A walk-in gets connected to a live provider in about a minute, or you can send a screening link ahead of the appointment so the patient arrives already cleared. One exam can also clear a patient for multiple treatments at once, which is where per-exam pricing usually punishes a practice that's adding services.

A few specifics worth having straight, because the pricing works differently by exam type:

• Simple exams are $19.99. These clear a patient for treatment like tox, filler, IV therapy, and vitamin injections.
• Prescriptive exams carry no separate exam fee. GLP-1s, peptide protocols, and other prescribed therapies have that cost built into the medication price.
• A $35 in-depth exam through your medical director is also available when a case calls for it.

If your GFE workflow is the thing you'd least like a board to look at

That's fixable, and you don't have to rebuild your practice to do it.

Our Established Nurse Membership bundles the medical director, a compliant practice structure, vendor pricing, and $19.99 on-demand exams for $799 a month, month to month. We subsidize the exam price for our members because we believe in nurse success. There's no new-injector training folded in, because if you're reading this you finished that part a long time ago.

If you want to see how the directorship side of that number compares to what you're paying now, we broke it down here: The Real Math on Medical Directorship for a Nurse-Owned Practice.

Book a few minutes with us and we'll walk through your current setup honestly, including the parts that are already fine.

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