There is no national answer. Among the states we verified from primary text, about ten expressly let an asynchronous store-and-forward interaction form the relationship and support a prescription, nine say a questionnaire by itself is not enough, four effectively require a live encounter, and two say nothing on point. Two states moved in 2026, which makes most published guides wrong.
California is the permissive one, which surprises people
Operators usually assume California is the strictest state on the list. Since 2019 it has been the most explicit in the other direction. The required prior examination “does not require a synchronous interaction” and “can be achieved through the use of telehealth, including, but not limited to, a self-screening tool or a questionnaire,” subject to the standard of care.
Read the last clause as the real rule. The statute permits the tool. The standard of care still decides whether that tool was adequate for this patient and this drug.
Ohio sits in the same bucket without naming questionnaires: a professional “may provide the telehealth services through the use of synchronous or asynchronous communication technology provided that the standard of care for an in-person visit can be met,” and the statute extends that to an initial visit. Washington’s Uniform Telehealth Act says a relationship “may be established through telehealth,” excludes email, instant messaging, text and fax, and bars a board from limiting “the telecommunication technology that may be used.”
Texas permits it, then gates it on what you actually looked at
Texas is the most useful model because it separates the modality from the evidence. The statute allows “asynchronous store and forward technology,” on its own or with synchronous audio, but only where the practitioner uses clinical information from “clinically relevant photographic or video images, including diagnostic images” or “the patient’s relevant clinical records.”
Self-reported answers on a form are neither of those. There is no questionnaire prohibition in the Texas telemedicine statute, and anyone who tells you there is has misread it. The gate is evidentiary: did the clinician look at an image or a record?
Texas also puts a second pair of eyes on it. A pharmacist “shall not dispense a prescription drug if the pharmacist knows or should have known that the order for such drug was issued without a valid pre-existing patient-practitioner relationship,” and the rule lists as a red flag “knowledge by the pharmacist that the prescription was issued solely based on answers to a questionnaire.”
The states that ban a questionnaire mostly ban a static one
This is the distinction that decides whether your intake is a product problem or a legal one.
Idaho defines the term: a “static online questionnaire” is one “to which the patient responds with a static set of answers,” and treatment based solely on one “does not constitute an acceptable standard of care.” New Jersey bars a prescription “based solely on the responses provided in an online static questionnaire.” North Carolina’s board says diagnosis or prescribing based “solely on static online questionnaires” is not acceptable, and then says what it wants instead: clinicians “should have the ability to ask follow-up questions or obtain further history.”
An adaptive interview that branches on the patient’s answers, escalates to a clinician, and can request more information is a different product from a fixed form. The statutes are drafted at that difference.
Two states go further, and operators should know both:
- Kentucky is the strictest we found. An “electronic, on-line, or telephonic evaluation by questionnaire is inadequate for the initial evaluation of the patient or for any follow-up evaluation.” The follow-up clause is a direct problem for automated refill cadence.
- Arkansas is the bluntest. Its board rule says “A patient completing a medical history online and forwarding it to a Provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.” If anyone tells you “store and forward” is a magic phrase, that is the sentence to show them.
New Jersey also conditions the asynchronous pathway on something most intakes skip: the provider may use store-and-forward “after accessing and reviewing the patient’s medical records.” A questionnaire with no records review does not satisfy it.
Where a live encounter is effectively required
- West Virginia. The relationship “may not be established through” text-based communications “such as e-mail, Internet questionnaires, text-based messaging.” Store-and-forward works only in combination with interactive audio at the initial encounter.
- Georgia. Treatment by electronic means is unprofessional conduct “unless a history and physical examination of the patient has been performed by a Georgia licensee,” and the telemedicine rule requires diligent efforts to have the patient “seen and examined in person” at least annually.
- Tennessee. Telemedicine “is not an audio only telephone conversation, email/instant messaging conversation or fax.”
- South Carolina. At each encounter, “threshold information necessary to make an accurate diagnosis must be obtained in a medical history interview conducted by the prescribing licensee.” Note “at each encounter.”
Two changes in 2026 that make older guides wrong
Missouri loosened, on August 28, 2026. The old flat sentence, that a questionnaire “does not constitute an acceptable medical interview and examination,” is gone. The current test is conditional: a questionnaire “shall be reviewed by the treating health care professional” and must contain information sufficient “as though the medical evaluation has been performed in person, otherwise such questionnaire does not constitute an acceptable medical evaluation.” A separate clause requires the provider to be employed by or contracted with a business entity licensed to provide health care in the state. Any write-up of Missouri from before this fall is describing a repealed sentence.
Louisiana tightened, on May 22, 2026, and only for weight management. A new provision bars the boards from prohibiting telehealth for obesity treatment or weight management, but the protection applies only where the provider “conducts a synchronous interaction with the patient.” For a GLP-1 program, that makes Louisiana a synchronous state.
Drug class changes the answer as much as the state
| Situation | What governs |
|---|---|
| GLP-1s, non-testosterone hormones, topicals | State relationship and standard-of-care rules only. No federal in-person rule applies |
| Any drug in Virginia | Schedule VI captures every drug labeled “Rx only,” so Virginia’s store-and-forward conditions reach ordinary prescriptions |
| ED drugs in Minnesota | Named in the invalid-without-examination list. Telehealth can satisfy the examination, but a documented evaluation is required |
| Weight management in Louisiana | Protected only with a synchronous interaction |
| Any controlled substance | A separate federal problem |
That last row deserves a sentence of its own. The federal telemedicine flexibility that expires December 31, 2026 is keyed to an “interactive telecommunications system,” which the cross-referenced definition describes as two-way and real-time. Asynchronous store-and-forward is a different category in the same regulation. It was never an asynchronous pathway for controlled substances.
The pharmacy is the other checkpoint
Your prescription has to be filled by someone. Florida makes it a disciplinary offense to dispense when the pharmacist “knows or has reason to believe that the purported prescription is not based upon a valid practitioner-patient relationship.” Minnesota bars a pharmacist from dispensing a drug the pharmacist “would reasonably be expected to know” rests on an invalid order, and applies the same rule to out-of-state pharmacies licensed there. California bars furnishing dangerous drugs over the internet “without a prescription issued pursuant to an appropriate prior examination.”
We looked for a board order or agency action from 2021 to 2026 where questionnaire-only prescribing was the stated violation, and did not find one we could verify from a primary source. The practical enforcement is quieter: the pharmacy simply stops filling.
What this means for you
Sort your states into three buckets, not two: expressly permissive, conditional, and synchronous-only. Then fix the product, because most of the risk is in the intake design rather than the state list. If your questionnaire branches on answers, escalates to a clinician who can ask for more, pulls records or images where the state requires them, and produces a documented decision that sometimes says no, it survives in most of these states. If it is a fixed form that auto-approves, it fails in nine of them and is thin clinically everywhere else. Then check Kentucky’s follow-up clause against your refill flow, and Louisiana against your weight-management flow. Licensure follows the patient is the gate before any of this, and the good faith exam rules of the patient’s state sit on top. If you buy exams from a vendor, the questions to ask include which of these buckets they operate in.
Related reading
Frequently asked questions
Can you prescribe from an online questionnaire?
It depends on the state and the drug. California expressly permits a self-screening tool or questionnaire if the standard of care is met. Idaho, New Jersey, North Carolina, Delaware, Hawaii, South Carolina, Arkansas, Kentucky and Missouri restrict it, most of them by targeting a static form rather than an adaptive interview with a clinician in the loop.
What is store-and-forward telehealth?
The transmission of a patient’s medical information from one site to a clinician at another, reviewed without the patient present. Roughly ten states we verified expressly allow it to establish a relationship. Arkansas warns that a patient sending in an online medical history does not qualify as store-and-forward at all.
Which states require a live video visit to prescribe?
West Virginia bars forming the relationship through internet questionnaires and requires interactive audio at the initial encounter. Georgia requires a history and physical by a Georgia licensee plus an annual in-person visit. Tennessee excludes audio-only and text. Louisiana requires a synchronous interaction for telehealth weight management.
Did Missouri change its telehealth questionnaire rule?
Yes. Effective August 28, 2026, Missouri replaced its flat prohibition with a conditional test. A questionnaire must be reviewed by the treating health care professional and must contain information sufficient as though the evaluation had been performed in person. Guides written before that date describe a repealed sentence.
Does asynchronous telehealth work for controlled substances?
No. The federal exception that allows prescribing without an in-person evaluation is keyed to an interactive telecommunications system, which is defined as two-way and real-time. Asynchronous store-and-forward is a separate category in the same regulation. That federal authorization also expires at the end of December 31, 2026.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.