What to ask before hiring a chiropractic marketing agency

By the middle of February a practice knows how January went: the resolution patients, the shoveling injuries, and the deductible reset showing up as care plans paused until spring. It is also when the agency pitches land, timed for owners reviewing their spend.

Most of those pitches were written for any local business. A chiropractic practice has a licensing board, federal privacy rules and ad platforms that treat health as a sensitive subject, and an agency that misses that builds things you later pay to tear out.

Five questions for every agency at the table

These are the questions we would ask from your side of the desk, including of us.

What will you install on my website, and on which pages?

Ask for a page-by-page list of every tag, script and tracking tool they plan to add. Listen for one thing: whether anything from Meta, Google or anyone else will sit on your intake forms, booking pages or patient portal.

The HHS Office for Civil Rights issued guidance on tracking technologies in December 2022 and revised it in March 2024. On June 20, 2024, a federal court in Texas, in American Hospital Association v. Becerra, vacated one piece of it: treating an IP address plus a visit to a public page about a condition or a provider as protected health information. HHS withdrew its appeal that August. Holland & Knight’s analysis notes that the remainder of the guidance was not affected, so pages where a patient hands over their details are still covered.

A good answer: nothing from an ad platform on the intake form, the booking widget or the portal, with calls and forms tracked by vendors willing to sign a business associate agreement. A worrying one: “we put the Meta pixel on every page, it’s standard.”

How will you know what worked if the ad platforms can’t see bookings?

From January 1, 2025, Meta stopped accepting middle and bottom-funnel event data from advertisers whose data it classed as health and wellness, according to the privacy vendor Ours Privacy. Separately, Google treats health conditions as a sensitive interest category, and ads in it cannot use Customer Match, remarketing lists or lookalike audiences; an ad about chronic back pain plausibly counts.

So a report built on what the ad platform says it booked does not hold up for a practice. Ask what they will count instead. The right answer is a written definition, such as a new patient exam booked and attended, counted in your own scheduling system or CRM with its source attached.

Have you read my state board’s advertising rule?

Ask them to name it. If they cannot, they have not read it.

The differences reach the words on the page:

• Florida. Rule 64B2-15.001 deems an ad misleading if it claims quality or suggests you are superior to other chiropractors. An ad for free X-rays must say they are given only if medically necessary, and Florida Statute 456.062 requires a disclaimer in capital letters on free or discounted offers.
• Texas. A licensee who uses “doctor” or “Dr.” in advertising must also use “doctor of chiropractic,” “D.C.,” “chiropractor” or “chiropractic,” and may not claim to be “Board Certified” by the Texas board itself.
• California. The board counts waiving deductibles or co-pays as unprofessional conduct when it is used as an advertising or marketing tool, unless the insurer is notified in writing.

Above all three sits the FTC, whose Health Products Compliance Guidance from December 2022 says a testimonial is no substitute for competent and reliable scientific evidence, and a “results not typical” line does not cure a deceptive claim. An agency whose sample ads promise to end sciatica in three visits has told you enough.

How will you get reviews, and who writes the replies?

Two rules settle the first half. Google’s Maps content policy bans offering anything in exchange for a review and bans asking selectively, only of the people likely to leave praise. Under the federal rule against fake reviews and testimonials, announced in August 2024, the FTC can seek civil penalties against knowing violators, including for reviews bought on condition of a particular sentiment. Every patient gets the same ask, not only the ones who scored you a ten on a survey.

The replies are where agencies trip. BrightLocal’s Local Consumer Review Survey, published last week, found 89% of consumers expect owners to respond to reviews, and templated or generic responses make 50% unlikely to choose a business. A provider, though, cannot confirm in a reply that the reviewer is a patient. Mintz reported that the Office for Civil Rights settled with a dental practice for $23,000 after it disclosed patient names, treatment and insurance information in replies on Yelp.

Ask the agency to draft three replies on the spot: to a five-star review, a one-star review about billing and a complaint about a long wait. Each should read as written by a person, and none should mention care, a visit date or anything that confirms the reviewer was treated.

What happens when a Local Services Ads call rings at 10:40 on a Tuesday?

Local Services Ads list chiropractors as a category that can earn the Google Verified badge, but health care gets a reduced version: no message leads, no booking leads, no call recordings and no lead credits. Every lead is a live phone call, and one that rings out is still billed.

CallRail’s January 2025 report found healthcare had the highest missed call rate of the industries it measured, at 32%. An agency selling you Local Services Ads without asking who picks up during adjustments is selling half a system. Ask what happens to the call your front desk cannot take: voicemail, a text back, a person, or an answering agent that hands off to staff.

What the first 90 days and the first report should show

Expect an order close to this:

1. Weeks one to three: the tag audit, call tracking and the written definition of a new patient.
2. Weeks two to six: website and profile copy checked against your board’s rule, and the review ask and reply routine running.
3. Weeks three to twelve: the Local Services Ads application, which Google says averages three to four weeks of screening, then search campaigns built without remarketing lists.

The first monthly report should fit on one page: calls received and answered, exams booked and attended, cost per attended exam by source, and new reviews with their replies. If it opens with impressions and clicks, ask where the patients went.

What to do this month

• Get the list of every script on your site from whoever built it.
• Write down your definition of a new patient and check that your schedule records each one’s source.
• Print your state board’s advertising rule and bring it to every pitch.
• Reread your last ten review replies as a stranger would, and rewrite any that confirm treatment.
• Call your own office at 10:40 on a weekday and note who answers.

None of these questions needs a marketing background, and the answers sort agencies within one meeting. To see how we answer them ourselves, start with how we work with chiropractic practices, then how we run review requests and replies inside a practice’s privacy rules.