Questions for any agency pitching your PT clinic

Six weeks into the year, a physical therapy clinic can usually read what January did to it. Medicare patients started over with a Part B deductible that rose to $283 for 2026, calendar-year commercial plans reset too, and a few plans of care went on hold. January also brings agency pitches, timed for owners reviewing their spend.

Most of those pitches were written for any local business. Whether a patient can book a PT clinic directly depends on the state and the patient’s plan, Medicare wants a physician or nonphysician practitioner to certify the plan of care, and federal privacy rules reach all the way into the forms on your website. An agency that misses those three things builds something you later pay to undo.

Six questions to ask every agency, us included

What is our state’s direct-access rule, in one sentence?

APTA reports that as of July 1, 2025, every state, the District of Columbia and the US Virgin Islands allow patients to see a physical therapist without a referral, either provisionally or without restriction. Its 2025 report counts 21 states with unrestricted direct access. The other 29 attach limits on time, visit counts or specific procedures.

The limits shape the copy. Texas lets a PT evaluate without a referral and, since November 1, 2025, treat for up to 30 consecutive calendar days, provided the therapist has held a license for at least a year, carries the required liability coverage and gets the patient to sign the board’s disclosure form first. Florida lets treatment run 30 days on a condition no practitioner has assessed before a practitioner of record must review and sign the plan. Insurers move as well: Aetna dropped its referral and signed plan of care requirement for physical therapy on June 17, 2025, which APTA says affected more than 26 million members.

A good answer names your state’s rule and drafts the sentence for your site and Google profile. A weak one talks only about lunches with referring offices. APTA’s own checklist asks clinics whether patients in the community know they can come in without a referral.

What will you install on our intake, scheduling and portal pages?

Ask for the list in writing, page by page. In July 2023 the FTC and HHS sent a joint letter to about 130 hospital systems and telehealth providers warning them about tracking technologies, naming the Meta pixel and Google Analytics. Tracking guidance from the HHS Office for Civil Rights, issued in December 2022 and revised in March 2024, was partly vacated by a federal judge in Texas on June 20, 2024. The vacated part was narrow: public pages that need no login. HHS filed an appeal that August and moved to dismiss it ten days later.

Morrison Foerster still advises minimizing or eliminating tracking on authenticated pages, and describes a wave of lawsuits brought under wiretap laws. The answer you want is short: nothing from an ad platform where a patient logs in, books or completes intake, and calls and forms measured with tools that keep health details away from Google and Meta.

How will you bring back patients who stopped coming?

This is where much of a clinic’s revenue hides. WebPT, which sells PT software, wrote in 2017 that roughly 70% of patients do not complete their full course of care. It gave no method, so treat that as a vendor’s claim.

HIPAA draws the line. Under 45 CFR 164.508, a covered entity needs the patient’s authorization before using protected health information for marketing, apart from narrow exceptions. The definition of marketing in 164.501, however, leaves out a provider describing its own health care services, unless a third party pays for the message. A clinic texting its own discharged patients about its own services is a different matter from an agency uploading your patient list to an ad platform. Ask which they intend, and have your compliance lead approve the wording.

Who will set up our therapists’ Google profiles?

Google’s Business Profile guidelines give an individual practitioner a profile of their own if they work in a public-facing role and can be reached at the verified location during stated hours. Where several practitioners share a location, the clinic keeps its own profile, separate from theirs, and each practitioner’s profile title should carry only the practitioner’s name.

An agency that wants to add “best sports PT” and a neighborhood to a therapist’s profile name has not read that page. One that first asks which therapists see patients during posted hours has.

Will you geofence the hospital or the clinic across town?

The answer should be no. Washington’s health data law makes it unlawful to set a geofence around a provider of in-person health care and use it to send ads about health care services, and it defines a geofence as a virtual boundary 2,000 feet or less from the location. Outside Washington, check your own state’s privacy law first, then ask yourself whether a patient who noticed the ad would ever book.

What happens to a Local Services Ads call nobody picks up?

Physical therapist is a Local Services Ads category with the Google Verified badge, but health care gets a pared-down product: phone calls only, with no message leads, no booking through the ad, no call recordings and no lead credits. Screening includes National Provider Identifier verification and averages three to four weeks, and health care cannot run ads while it is pending. CallRail’s January 2025 report found healthcare missing 32% of its calls, the worst of any industry it measured. An agency should ask who answers during treatment hours before asking for budget.

What the first 90 days and the first report should show

Expect roughly this order, whoever you hire:

• Weeks 1 to 2: a tag audit, pixels off intake and portal pages, call tracking on.
• Weeks 2 to 6: clinic and therapist profiles corrected, your direct-access rule on the site, search campaigns on injury searches and the Local Services Ads application.
• Weeks 4 to 10: reminders for patients partway through a plan of care, and recall of last year’s discharges through your own channels.
• Weeks 6 to 12: review requests at discharge and replies that never confirm someone was treated.

The first report should split new evaluations into self-referred and physician-referred, then show how many arrived, what each arrived evaluation cost by source, and how many planned visits were completed. For scale, LocaliQ’s healthcare benchmarks, published in December, put the median Physical Therapy search lead at $32.79 for campaigns run from October 2024 to September 2025, with 15.35% of clicks becoming leads. A report that opens with impressions has skipped the part you pay for.

What to do this month

• Write your state’s direct-access rule in one sentence and check that your site says it.
• Ask whoever built your site for a list of every script on the intake, scheduling and portal pages.
• Pull last year’s discharges and count how many patients finished their plan.
• Check that each therapist’s Google profile, where one exists, carries only the therapist’s name.
• Call your own front desk at 11 on a Tuesday morning and note who answers.

An agency worth hiring answers all six without reaching for its notes. We have written our own answers out on the page for physical therapy clinics, and the practitioner profile rules are covered in more depth on our Google Business Profile page.