The patient value you budget against is probably not yours
Chiropractic marketing gets sold on a lifetime value of
$2,000 to $3,000. At published per-visit rates that number needs a patient visit average in the
thirties, which is the top band of the profession. If you are in the first band, a new patient is
worth roughly a third of that, and every budget built on the bigger number overpays.
Flat fee, never a percentage of spend You own the account from day one Month to month, no setup fee
Under 12
Patient visit average that classifies a practice as pain-relief focused
Over 30
Patient visit average that means you are holding patients into wellness care
$60-$90
Reported revenue per visit, which is what turns a PVA into money
$0
Landing pages built per campaign. No design fee.
1 The Number
Three practices, three different businesses
Chiropractic Economics classifies a practice by its patient visit average, and the
bands are not close together. What a new patient is worth to you depends almost entirely on which
of these you are in, and it is the number we ask for before we look at a single keyword.
Under 12 visitsPain-relief practice$700
12 to 24 visitsMoving beyond relief into functional improvement$1,260
Over 30 visitsRetaining patients into wellness care$2,380
Bands as published by Chiropractic Economics. The value column is that band at
$70 a visit, inside the $60 to $90 range reported in chiropractic association survey data. Bars are
scaled to the top band.
The $2,000 to $3,000 lifetime value chiropractic marketing is usually sold on sits in
the bottom row. At $70 a visit it needs a PVA of roughly 29 to 43. If your practice is in
the first band, a new patient is worth around $700, and a $200 acquisition cost is a very
different conversation.
2 The Consequence
Why this decides your whole budget
01
The wrong number sets the wrong ceiling
Every bid, every budget and every channel decision is downstream of what you believe a patient is worth. Get that wrong by three times and you are not making small errors, you are making one large one repeatedly.
02
Marketing gets blamed for a clinical retention problem
When patients leave after the relief phase, the account looks like it is producing poor patients. It usually is not. It is producing ordinary patients into a practice that has not converted them onto a plan.
03
The cheapest growth is not in the ad account
Moving your PVA by a few visits raises the value of every patient you have already paid to acquire, retroactively and at no media cost. No bid change available to us competes with that.
04
It changes which channel is right
A practice at the top band can afford Local Services Ads at a fixed price per lead comfortably. A practice in the first band often cannot, and should fix the plan conversion before scaling anything.
We are a marketing company telling you that the first thing to fix might not be marketing.
That is not modesty. It is that we would rather you kept paying us in year two,
and that only happens if the maths works from the start.
3 Your Number
What a new patient is actually worth to you
Your figures, not the brochure ones. It also prices what a small PVA improvement is
worth, because that is usually the largest number on the page. It runs entirely in your browser and nothing
leaves this page.
Patient value and acquisition ceiling
If you do not know your PVA, your practice management software does. Total visits divided by
unique patients over the same period.
$
%
$
What a patient is worth in revenue$0
Gross profit per patient$0
Most you should pay per patient at a 3 to 1 return$0
Your current return on acquisition0:1
What the PVA improvement is worth a year$0
4 The Audit
What we find in a chiropractic account
Not a sales list. These are what turn up again and again when we open one of these
accounts for the first time.
Structure
One campaign for every condition
Back pain, sciatica, a car accident case and a wellness enquiry are four different buyers with four different values. Run against one target, the cheapest of them sets the bid and the most valuable never gets served properly.
Measurement
Counting form fills, not new patients
The account cannot tell a booked new patient from a curious click unless you tell it. Without offline conversion import it optimizes toward whichever enquiry is cheapest to produce, which is rarely the one that completes a plan.
Economics
Nobody has stated the PVA
We ask for it on the first call. When it cannot be produced, the budget has been set against a number from a seminar rather than from the practice, which is the single most expensive assumption in this trade.
Offer
The discount that costs more than it brings
A $29 new patient special fills the diary with people shopping for $29. Those patients convert onto plans at lower rates, so the offer that lowers your cost per lead often raises your cost per completed plan.
Placement
The eligible category nobody mentioned
Chiropractor is a Local Services Ads category and the practice is not in it. For a business where a new patient has a knowable value, paying a fixed price per lead is easier to govern than paying per click.
The good news
Most of it is structural
None of the above needs a bigger budget. They are wiring and measurement problems, and they are cheap to fix relative to what they cost while they sit there.
5 The Work
How we actually run chiropractic accounts
01
Start from your PVA, not our template
The first deliverable is your real patient value, worked out from your numbers. Everything after it, budget, bids, channel mix, is set against that figure rather than an industry average.
02
Separate by condition and by intent
Acute pain, sciatica and disc, personal injury, and wellness or maintenance each get their own campaign. They convert differently, they are worth different amounts, and they should never share a bid.
03
Import the new patient, not the enquiry
Call tracking, then offline conversion import so the account learns which enquiries actually became new patients. This is the change that moves accounts most and the one almost nobody has running.
04
Keep the offer honest
If a discount is the entry point, we want to know how those patients convert onto plans compared with full-price enquiries. If they convert worse, the offer is a cost, and we will show you that rather than defend it.
05
Build the pages, at no charge
Sending sciatica traffic to a general homepage wastes the most valuable click you buy. Each campaign gets a page written for that condition. We do not charge for them.
06
Say when the answer is retention
If your PVA puts a patient below what you are already paying to acquire one, more traffic makes it worse. We would rather say that on the first call than bill you for a year of it.
Flat Fee Pricing
Flat fee, and the landing pages are included
No setup fee, no annual contract, no commitment. Month to month, cancel any time.
LSA Management
$445/mo
Full LSA setup, screening support, lead rating and disputes, review strategy, bid tuning. Drops to $300/mo when we also run your Google Ads.
“ You will own your Google Ads account, Local Services Ads account, tracking systems, landing pages, and conversion data from day one. Your accounts stay in your name. Your billing stays on your card. Your data stays yours. If you decide to leave, everything stays with you. No account transfers. No hostage situations. No starting over from scratch. ”
JulianAuthor at Blue Grid Media
6 Straight Answers
Practice owner questions, answered honestly
Why are you talking about PVA instead of cost per lead?
Because cost per lead is the easy half. Chiropractic marketing is almost always budgeted against a patient lifetime value of $2,000 to $3,000. At the $60 to $90 per visit that published association survey data reports, that figure implies a patient visit average somewhere in the thirties. Chiropractic Economics classifies a PVA above 30 as a practice retaining patients into wellness care, which is the top tier, and a PVA below 12 as a pain-relief practice. Budget against the top tier while running at the bottom one and you overpay on every patient you buy.
What counts as a normal PVA?
Chiropractic Economics gives three bands. Under 12 is a pain-relief practice. Twelve to 24 means you are moving patients beyond relief into functional improvement. Over 30 means you are holding them into wellness care. Where you sit changes what a new patient is worth by a factor of three or more, which is why it is the first number we ask for.
We do not track PVA. Can you still help?
Yes, and that is the common case. Your practice management software has it, or it can be derived from total visits divided by unique patients over a period. If you genuinely cannot produce it, that is itself the finding, and it is worth more than any bid change we could make in the first month.
Can chiropractors run Local Services Ads?
Yes. Chiropractor is one of Google's Local Services Ads categories. It charges per lead rather than per click and sits above the regular search ads. It suits a practice with a healthy PVA, because paying a fixed price for a new patient is much easier to justify when you know what that patient goes on to complete.
Do you guarantee a number of new patients?
No, and be careful with anyone who does. We do not control your front desk, your report of findings, your care plan conversion or your reactivation process, and those decide whether an acquired patient becomes a completed plan. What we commit to is the work: campaigns split by condition, call tracking, offline conversion import so the account optimizes toward booked new patients rather than form fills, and an audit you can read without us in the room.
Should we be running Meta ads instead?
A lot of chiropractic marketing is sold on Facebook, and the search data reflects that. It can work for offer-led acquisition, but it tends to bring patients in on a discount, and discount-led patients are the ones most likely to leave before the plan completes. That is a PVA problem dressed up as a cheap lead. We would rather fix the search side first.
What about personal injury cases?
Personal injury is a different campaign with different intent, different case value and different competition, and it should never share a budget with wellness or general back pain traffic. If PI is part of your practice, it gets separated on day one.
What does it cost?
$445/mo for Local Services Ads management, from $695/mo for Google Ads, $995/mo for both. Flat fee, not a percentage of spend, month to month, no setup fee. Landing pages are included. Your ad spend goes to Google directly on your own card.
7 The Plan
What actually happens in the first 90 days
Days 1 to 30
Establish the real number
Your PVA and revenue per visit pulled from your own system
Full account audit, written so you can read it without us
Offline conversion import live, keyed to booked new patients
Negative keyword work against student, DIY and job-seeker traffic
Condition landing pages built, at no charge
Offer tested against full-price enquiries for plan conversion
Days 61 to 90
Move the targets
Bids re-set against new patients rather than form fills
Budget shifted toward the conditions that convert onto plans
Personal injury separated and scaled if it is part of your practice
A plain report of what changed, and what it cost
8 The Boundaries
What we will not do
Promise you a number of new patients. Too much of the outcome sits on your side of the front desk for that promise to be honest.
Charge a percentage of your ad spend. It pays us to tell you to spend more, which is the wrong incentive to have in the room.
Hold your account. It is in your name, on your card, from the first day to the last.
Budget against an industry lifetime value. We use your PVA or we do not quote a ceiling at all.
Write clinical claims for you. We will not put treatment claims in an ad that your practice has not approved, and healthcare advertising policy is not a place to improvise.
Take on more accounts than we can run. Twenty per account manager, which is the reason we sometimes say no.
Deeper reads for practice owners
The research behind this page, and the tools we use when we run your numbers with you.
The first audit is free. So are the landing pages.
30 minutes. We work out what a new patient is actually worth to your practice, then tell you
whether advertising is your constraint. If it is not, you will get that answer instead.
