A DC we spoke with last year had been through three agencies in four years. Same pattern each time: a good sales call, a decent-looking proposal, an onboarding form, then silence punctuated by a monthly PDF of impressions. He blamed the agencies. Two of them probably deserved it. But when we asked what he had actually told them — what a good month looked like, what his capacity was, which services he wanted more of — he didn't have an answer. He had hired three vendors and briefed none of them.
That's the part nobody sells you. The hiring decision matters less than the brief, and the brief is yours to write. An agency that is competent and badly briefed will produce competent work aimed at the wrong target. You'll pay for it for six months before anyone says so out loud.
This post is about the two weeks around signing: how to evaluate the shortlist, what to put in writing, and how to set up the first 90 days so you can tell early whether it's working.
Decide what you're buying before you take a sales call
Agencies sell what they're good at, not what you need. If you walk in without a position, you'll leave with whatever was on their slide deck. So write one sentence first: what has to be different in six months for this to have been worth it?
Most practices fall into one of four situations, and each one points at different work:
| Situation | The real problem | What you're actually buying |
|---|---|---|
| New or under a year old | Nobody knows you exist | Visibility: site, Google Business Profile, local ads, launch sequence |
| Steady but flat | Not enough top-of-funnel | Acquisition: SEO, paid, referral channels |
| Plenty of leads, weak schedule | Conversion and follow-up | Phone handling, speed to lead, report of findings, reactivation |
| Full schedule, high churn | Retention and patient experience | Reminders, rebooking, reviews, communication systems |
The third and fourth rows are the ones agencies most often get wrong, because the fix isn't an ad campaign — it's your front desk and your follow-up. If your leads are fine and your bookings aren't, buying more leads makes the problem more expensive. Run the numbers in the cost-per-new-patient math before you decide you have a traffic problem.
The six questions that separate agencies
Everyone will say yes to "do you work with chiropractors." These are harder to fake.
- Who does the work, and will I meet them? The person on the sales call is often not the person writing your copy. Ask for the name and role of whoever touches your account weekly.
- Show me a client in a market like mine — and one that didn't work. The second half is the real question. An agency that can't describe a failure honestly either hasn't had one (unlikely) or won't tell you when yours is going sideways.
- What do you need from me each month? Good answers: photos, a short video every couple of weeks, access to practice numbers, 20 minutes on a call. An agency that says "nothing, we handle it all" is telling you the work will be generic.
- How do you handle state board rules and testimonials? Advertising rules vary by state — offer language, before/after claims, testimonial use, and how you describe credentials. An agency that has never asked about your board is going to write something you have to take down.
- What happens to my assets if I leave? Website, domain, ad accounts, Google Business Profile, tracking numbers, email list. The answer should be "they're yours and they're in your accounts."
- What would you tell me not to spend money on? Anyone who thinks you need all seven services at once is selling, not advising.
Add a seventh if you're buying leads rather than services: understand the structure. Pay-per-lead and retainer models fail in different ways, and the failure mode matters more than the price.
Red flags that are worth walking away over
- Guaranteed rankings or guaranteed new patient counts. Nobody controls Google's results or your market's demand. A guarantee means either a loophole in the contract or a willingness to say anything.
- They own your website. Proprietary platforms you can't export are a rental, not an asset. If leaving means rebuilding from zero, the renewal conversation isn't a real conversation.
- Reporting that leads with impressions and reach. Ask what the first slide of the monthly report is. If it isn't leads, calls, and booked new patients, you're going to be reading a vanity document.
- No access to your own ad accounts. You should be an admin on everything with your name on it.
- A 12-month lock with a 90-day ramp and no exit. Ramps are real. Locks with no performance condition are a financing arrangement, not a partnership.
- They want your patient list without mentioning HIPAA. Any agency touching patient names, phone numbers, appointment data, or email addresses needs a Business Associate Agreement and a clear answer about where that data lives. If they look surprised when you ask, stop.
Write the brief yourself — one page, eight items
Agency onboarding forms are designed to collect what the agency needs to start. They are not designed to tell the agency what success looks like for you. Write that part yourself, before kickoff, and send it as a document. One page. It takes about 40 minutes and it is the highest-leverage thing you will do in the whole relationship.
The eight items:
- Goal in one sentence, with a number and a date. "Add eight to ten new patients a month by the end of Q2, weighted toward cash wellness care rather than personal injury."
- Capacity. How many new patients can you physically see per week, and on which days. Marketing that fills Tuesday when you need Thursday is a failure dressed as a win.
- Services you want more of, and less of. Be blunt. If you're trying to move away from a payer mix that's killing you, say so.
- Your actual patient. Not "everyone with back pain." Age, neighborhood, what brings them in, what they googled. If you don't know, pull your last 30 new patients and look.
- What you've already tried and what happened. Including the stuff that failed. Especially the stuff that failed.
- Constraints. Budget ceiling, state board rules you know about, anything you won't say in an ad, competitors you'd rather not name, times you're closed.
- Who decides and how fast. Name one approver. Commit to a turnaround — 48 hours is reasonable. Slow approvals are the single most common reason campaigns underperform, and the agency will never tell you that in month two.
- How you'll judge it in 90 days. Write the criteria now, while you're calm.
Goal: 8–10 new patients/month by June 30, cash wellness weighted. Capacity: 12/week, best Thu–Fri. Want more: family and prenatal. Want less: PI. Budget ceiling: $3,500/mo all-in including ad spend. Approver: me, 48hr turnaround. 90-day test: at least 25 booked new patient appointments attributable to agency channels, and I can see where each one came from.— A brief that fits in an email
Set the first 90 days so you can read the signal
Marketing has different clock speeds, and agencies rarely say this plainly. Paid ads give you a read in two to four weeks. Conversion fixes — phone handling, follow-up speed, rebooking — can move within a month because the volume is already there. SEO is a six-month question, minimum, and anyone who tells you otherwise is counting on you not remembering what they said.
So judge each workstream on its own timeline:
| Workstream | When to expect signal | What to look at at 90 days |
|---|---|---|
| Paid search / social | 2–4 weeks | Cost per booked appointment, not cost per lead |
| Conversion and follow-up | 30 days | Call answer rate, speed to first contact, book rate |
| Website rebuild | On launch, then 60 days | Phone taps, form fills, mobile load speed |
| Local SEO / GBP | 60–90 days for movement | Map pack impressions, calls from profile, review velocity |
| Organic SEO | 6+ months | Pages published, pages indexed, early ranking movement |
| Brand and video | Slow, compounding | Volume shipped and whether anything got reused |
Two things you should insist on from day one. First, call tracking that lets you hear the calls. Not to micromanage the front desk — to find out whether your "the ads don't work" problem is actually a phone problem. We've seen campaigns judged a failure where the real issue was unanswered calls after 4pm. Second, a weekly number you track yourself, independent of the agency's dashboard. A short front desk scorecard is enough. If your numbers and theirs diverge, you want to find that out in week five, not month seven.
What a good monthly rhythm looks like
Thirty minutes a month, the same agenda every time:
- Last month's numbers, against the brief — not against last month's numbers.
- What they changed, and why.
- What they want to try next, and what they'd stop.
- What they need from you, with dates.
- One thing that isn't working and what's being done about it.
If the fifth item is empty three months running, either everything is perfect or you're not being told the truth. Ask directly. A good agency will have something ready — they're always testing things that didn't pan out.
Your side of the rhythm: send photos, say yes or no inside 48 hours, and tell them about things happening in the practice. A new associate, a competitor opening nearby, a slow month coming up — all of that changes what they should be doing. The practices that get the most out of an agency treat it like a department, not a vending machine. If a competitor does move in down the street, how you respond is a joint decision, and the agency can't make it if they find out from Instagram.
When to fire them, and how
Three legitimate reasons to end it: the numbers you agreed on at 90 days aren't close and there's no credible explanation; you can't get a straight answer about what was done last month; or they've asked you for nothing, which means the work is templated and your practice is interchangeable with every other client.
Not legitimate reasons: one bad month, a change that hasn't had time to work yet, or an SEO program at month three. Churning agencies every eight months is its own strategy, and it's a bad one — every switch costs you the ramp time again.
When you do leave, get the assets out first, then give notice. Domain registrar login, website files or export, Google Ads and Meta accounts transferred to your ownership, Google Business Profile primary ownership, call tracking numbers ported, any email list exported. Do it in that order. It is much easier to collect your property from a vendor who still thinks you're renewing.
Do this this week
- Write the one-sentence goal with a number and a date. Fifteen minutes.
- Pull your last 30 new patients and note where each one came from. If you can't, that's your first finding.
- Draft the one-page brief. Send it to any agency you're already paying — today, not at renewal.
- Check your Google Ads, Meta, and Google Business Profile accounts. Confirm you are an owner or admin on all three. Fix it if you're not.
- Ask your current or prospective agency the six questions above. Write the answers down.
The brief is the whole thing. Agencies are not mind readers and the good ones will tell you that. Give them a target, a timeline, and 48-hour answers, and you'll get more out of a mediocre agency than most practices get out of a good one. If you want to talk through which of the four situations you're actually in, book a call and bring your last 30 new patients with you.
Frequently Asked Questions
How much should a chiropractic practice pay a marketing agency?
It depends on what you're buying and whether ad spend is included, so ask every agency to quote fees and media separately. The more useful question is what a new patient is worth to you over the life of their care, and what you can afford to spend to acquire one. Work that number out first, then judge any proposal against it rather than against another agency's price.
How long before a marketing agency should show results?
It varies by channel. Paid ads should give you a read within two to four weeks, conversion and follow-up fixes within about 30 days, and local profile work in 60 to 90 days. Organic SEO is a six-month question at minimum — judge it on pages published and indexed early on, not on revenue.
Should I sign a 12-month contract with a marketing agency?
A term commitment is reasonable for work that takes time to compound, like SEO or a website rebuild. What's not reasonable is a lock with no performance checkpoint and no exit. Ask for a 90-day review with agreed criteria written into the agreement, and make sure you own your domain, ad accounts, and Google Business Profile regardless of how it ends.
Does a marketing agency need a HIPAA Business Associate Agreement?
If they touch patient names, phone numbers, email addresses, or appointment data in any form — including reactivation campaigns, reminder systems, or review requests — yes, you need a BAA and a clear answer about where that data is stored and who can access it. An agency that hasn't raised this before you did is a problem. Talk to your own compliance counsel about your specific setup.