Red flags when hiring an agency

Most agencies are trying to do good work. A few warning signs, though, show up again and again in the relationships that go badly. One of them alone may have an innocent explanation. Several together usually don’t.

Promises nobody can keep

• Guaranteed rankings. Google’s own guidance on hiring an SEO says no one can guarantee a top ranking. An agency that guarantees first place, or a set number of new patients, is either taking a risk you’ll pay for or defining the guarantee so narrowly it means little. Ask exactly what is guaranteed and what happens if it isn’t met.
• Results too fast. SEO takes months. A promise of quick ranking wins usually means shortcuts such as bought links or keywords stuffed into the practice name.

Ownership problems

• “We own the website” or “we own the ad account.” The agency should work inside accounts the practice owns. If the domain, profile, ad account or tracking numbers are in the agency’s name, leaving can mean losing them. The GBP ownership chapter shows how this works on the profile.
• Refusing to share logins or admin access to accounts the practice pays for.

Contracts and reports

• Long terms that renew automatically, with a short window to cancel and a large fee to leave early. A minimum term for setup work can be fair; being locked in indefinitely isn’t.
• Vague reports full of impressions, “visibility” and ranking screenshots, with nothing about calls or booked new patients, and no way to check the numbers yourself.
• Invoices that don’t separate ad spend from fees.

Tactics that put the practice at risk

• Fake, bought or incentivized reviews, review gating or promises to remove negative reviews. Google prohibits them, and the FTC’s rule on fake reviews and testimonials can apply to the business that benefits, not just the vendor. The practice carries the risk either way.
• Cookie-cutter websites and city pages: the same template and articles used for dozens of practices, or near-identical pages for every nearby town. The local SEO guide explains why those backfire.
• Exclusivity claims used as pressure. “We only take one practice per city, and your competitor is about to sign” may be true, but it’s not a reason to skip reading the contract. Ask what the exclusivity covers and put it in writing.
• Brushing off compliance questions about patient privacy or your state board’s advertising rules.