Cleveland Chiropractic Another Step Up
May built on the record April. Leads climbed again, the all-in cost per lead fell further, and the practice logged 155 confirmed PracSuite bookings across the last 28 days. We held the daily budget low while Jake recovers, so this efficiency came on a deliberately restrained spend. Inside: a small ads management pricing update with a three-month transition rate, and an option to bring your website up to the same standard as the results.
May Performance
Leads grew 78% on April while the all-in cost per lead fell another 37%, fully loaded with our $330 fee. The daily budget stayed at the reduced level set while Jake is off the floor, so this is more output from a deliberately careful spend.
Total Ad Spend
Up modestly from $505.78 in April. We nudged spend up slightly as the account proved it could convert efficiently, while still holding the reduced daily budget set during Jake's recovery.
Paid Leads (62 bookings + 11 forms)
62 PracSuite appointment bookings plus 11 website lead form submissions. Up from 41 in April (+78%). This deliberately excludes the 76 contacts, 31 direction requests and 43 page views Google also tracked: useful signals, but never counted as leads.
All-In Cost per Lead
Fully loaded with the $330 CAGM fee: $607 ad spend plus $330, across 73 leads. Down from $20.28 in April (-37%). Ads-only cost per lead is $8.27. Google Ads patients use the 50% off landing page ($62.50 first consult), so the account still pays back on the first visit alone.
Spend vs Results Four Months, One Direction
Four months of live data. Cost per lead is shown fully loaded, including the $330 you pay CAGM to manage the account. Every column moves the right way.
| Metric | February | March | April | May | Direction |
|---|---|---|---|---|---|
| Ad Spend | $572.63 | $593.55 | $505.78 | $607.00 | Steady |
| + CAGM Fee | $330.00 | $330.00 | $330.00 | $330.00 | Flat |
| All-In Cost | $902.63 | $923.55 | $835.78 | $937.00 | Steady |
| Leads | 28.0 | 26.8 | 41.2 | 73.0 | Up 78% |
| All-In Cost per Lead | $32.24 | $34.47 | $20.28 | $12.84 | Down 37% |
Total Direct Bookings
You asked to see the total volume of direct bookings each month, not just the ad-attributed ones. Here it is. This counts every confirmed booking across the practice, however the patient found you.
Confirmed Bookings (28 days)
Every confirmed PracSuite booking across the whole practice in the last 28 days, all channels combined: ads, organic, referral, repeat patients and walk-ins.
Bookings from Google Ads
Of the 155 total practice bookings, Google Ads is directly credited with 62 this period. Add 11 website lead form enquiries and that is 73 paid leads in total. The rest of the 155 comes from brand, organic search and returning patients.
New vs Existing Patients (30 days)
From the live booking tracking, across bookings where patient type was captured: 19 new patients and 59 returning, so close to one in four bookings is a brand-new patient. Once the conversion pipeline is live we bid specifically toward new patients and report this split every month.
Closing the Attendance Loop
What the research found
Enhanced Conversions for Leads is the right path
PrimaryMatch attended-and-paid appointments back to the ad click using the hashed email and mobile already collected at booking. More robust than GCLID alone against cookie loss and mobile booking, and Cleveland already captures both identifiers.
No PracSuite Zapier app exists
In-houseThere is no native PracSuite Zapier trigger. Rather than pay Zapier to be a middleman, we run a small poller on our own infrastructure that reads PracSuite and uploads to Google Ads directly. Cheaper, and we own the data integrity.
What it unlocks
Bid for attended new patients, not clicks
4 actionsFour conversion actions: Booking Submitted, Appointment Attended, Appointment Paid, and New Patient Confirmed. New Patient Confirmed becomes the primary bidding signal, so Google optimises toward patients who actually show up and are new to the practice.
The new-vs-existing split, automatically
AutoEvery attended appointment is checked for prior visits. New patients fire their own conversion. That gives you the monthly new-versus-existing split you asked for, and stops the bidder chasing cheap rebookings.
A Fair Heads Up on Pricing
Across the agency we are moving ads management to a single standard rate of $500 a month including GST, up from $330. Because you have been with us through the build, you get a three-month transition at a 20% discount, so the change lands gently.
Today, incl GST
Your current monthly ads management fee. At May's 73 leads, this is the $12.84 all-in cost per lead shown earlier.
Months 1 to 3, incl GST
The new $500 rate less a 20% transition discount, held for your first three months. At May volumes that is an all-in cost per lead of $13.79.
From month 4, incl GST
The standard agency rate for ads management. At May volumes that is an all-in cost per lead of $15.16, still well below April's $20.28.
A Website Built to Win AI Search
Where the current site falls short
A four-year-old WordPress build
2022The current site runs on WordPress and Elementor with a heavy page-builder bundle, so it is slow on mobile and likely failing Google's Core Web Vitals, which is exactly where most chiropractic searches happen.
Invisible to AI search
0 schemaNo schema markup and no llms.txt, so ChatGPT, Perplexity and Google AI Overviews have nothing clean to cite. The plugin stack is also a constant security and patching risk.
What the new build gives you
Fast, secure and modern
EdgeNext.js on Vercel renders near-instantly from the edge, passes the speed checks the current site fails, and has no plugins to hack. A fresh, branded design that looks current.
Built for AI search and bookings
GEOSchema and llms.txt so AI engines cite the clinic, and faster pages turn the same traffic into more booked enquiries. Your PracSuite booking carries over unchanged, so there is no disruption.
What Happens Next
CAGM Will Do
- 1Apply for the PracSuite Vendor Key: On your go-ahead, we start the Smartsoft application immediately, since approval is the long pole on the attendance-tracking pipeline.
- 2Build the conversion pipeline: Poller plus Enhanced Conversions upload on our infrastructure, with New Patient Confirmed as the primary bidding signal, reporting the new-versus-existing split each month.
- 3Hold the reduced daily budget: Keep the lower spend in place while you recover, then lift it in a measured way once you are back on the floor.
- 4Next monthly review: First week of July, same format as this one.
We Need From Jake
- !Go-ahead to apply for the PracSuite Vendor Key, plus an Account API Key generated from your PracSuite admin when ready
- !A quick reply on the PracSuite booking-page email we sent, to confirm the online-only appointment URL
- !Your best guess on when you are back on the floor, so we can plan the budget lift
- !OK to send hashed email and mobile to Google for measurement, a one-line privacy policy note covers it
Any Questions Jake?
May was another step up on a deliberately careful budget: more leads, a lower all-in cost per lead, and 155 confirmed bookings across the practice. The next move is closing the attendance loop so we bid for new patients who actually show up. Take it easy on the recovery, and we will keep the leads ticking over.