How to choose a marketing company for your chiropractic practice

If you run a chiropractic practice, you have probably been pitched by a marketing company this month. Some of them are excellent. Some will lock you into a year-long contract, build everything in their own name, and send you reports full of numbers that never become patients. The difference is usually visible before you sign, if you ask the right questions.

1. Who will own the website, the domain, and the accounts?

This is the question that matters most, and the one most often skipped. Your domain name, website, Google Business Profile, and ad accounts should belong to your practice. The agency should get access to them, not ownership of them.

• Domain. Whoever is listed as the registrant controls the domain. ICANN, the body that coordinates domain names, advises that letting a hosting provider, web developer, or law firm be the registrant "is generally not considered a good practice." Your practice should be listed.
• Ads. Google Ads lets you grant other people access at different levels, and agencies can link their manager account to yours. There is no need for an agency to run ads from an account you do not own.
• Google Business Profile. You can add an agency as a manager while your practice stays the owner.

A good answer: "Everything is in your name. We work inside it." A red flag: "We host everything for you," with no mention of what happens if you leave.

2. What exactly are you promising?

Be wary of guarantees about rankings. Google's own guidance on hiring an SEO puts it plainly: "No one can guarantee a #1 ranking on Google." A trustworthy agency will tell you what it will do, how it will measure progress, and what is outside anyone's control.

3. How will you measure success?

Impressions, clicks, and "reach" are easy to grow and easy to report. What you care about is new patients and what each one costs. Ask to see a sample report. A good one shows new patient inquiries, booked first visits, where they came from, and what was spent, in language you can repeat to your office manager.

4. Will you sign a business associate agreement?

If the agency will handle anything that includes patient information, such as appointment reminders, reactivation texts, intake forms, or a chat tool that collects symptoms, it is likely a business associate under HIPAA. HHS guidance says your practice needs satisfactory assurances "in the form of a contract," known as a business associate agreement, before that vendor handles protected health information. An agency that works with health practices should know this without being told.

5. How do you handle reviews and testimonials?

Listen for the rules in the answer. Patient testimonials with names or photos need the patient's written authorization under HIPAA. Reviews cannot be bought, rewarded, or filtered to only happy patients. And the FTC's Endorsement Guides require that testimonials describing unusual results make clear what results are generally expected. Our reviews post covers the details. If an agency's plan includes "review generation" with incentives or gating, walk away.

6. Who will actually do the work?

Many agencies sell with a senior person and deliver with a rotating team or an outside contractor. Ask who writes your content, who manages your ads, and who you call when something breaks. There is nothing wrong with a team, but you should know who is on it and be able to reach them.

7. What are the contract terms?

• How long is the commitment, and what does it cost to leave early?
• What do you get to keep if you leave: the website files, the content, the ad account history?
• Are setup fees refundable if the work is not delivered?
• Is ad spend paid directly to Google or Meta, or marked up through the agency?

Month-to-month terms after a reasonable setup period are a sign an agency expects to keep you by doing good work.

Red flags, in short

• Guaranteed first-page or number-one rankings.
• The website, domain, or ad account in the agency's name.
• Reports with no mention of patients or cost per patient.
• "Review generation" that offers rewards or screens out unhappy patients.
• No mention of HIPAA when patient information is involved.
• A twelve-month contract before any work is delivered.

Before your next sales call

Write these seven questions down and ask every agency the same ones, including us. The best answers will be specific, a little boring, and easy to check. That is usually the sign of a company that plans to earn its fee month after month.