Agencies and vendors can save a practice a great deal of time. They can also absorb a large share of the budget without anyone at the practice knowing what it bought. The fix is the same numbers you use everywhere else, plus a careful read of the contract.
Know what you’re paying for
- Ad spend is what goes to the platform, such as Google or Meta.
- Management fees are what the agency keeps for running it. They may be flat, a percentage of ad spend, or bundled into a package.
- Retainers cover ongoing work such as SEO, content, social media or website care.
- Setup and software fees cover call tracking, review tools, landing pages and reporting dashboards.
Ask for every invoice to separate these. If an agency won’t say how much of your payment reaches the ad platform, you can’t calculate cost per new patient, and you can’t compare them with anyone else.
Own your accounts
The practice should own its Google Business Profile, ad accounts, analytics, domain name, website and hosting, call-tracking numbers and social profiles, and give the agency access as a user or manager. If the agency owns them, leaving can mean losing your ad history, your tracking numbers or even your website. See the Google Business Profile ownership chapter for how that works on the profile.
Read the contract
- How long is the minimum term, and how much notice does cancellation take?
- Who owns the website, content, photos and ad creative you paid for?
- Do tracking numbers transfer to you when you leave?
- Will the vendor sign a business associate agreement if they handle patient information, such as call recordings or form submissions?
- Is any part of the fee tied to the number of patients or the revenue they produce? Arrangements like that can run into state dental board rules on fee splitting and, where government programs are involved, federal anti-kickback rules. Ask your state board or a healthcare attorney before signing.
Reports to demand
A useful monthly report answers the questions in your own dashboard, not just the agency’s favorite metrics:
- Total spend, split into ad spend and fees.
- Calls and form submissions, with tracking data you can check yourself.
- Booked new-patient appointments, matched against your practice management software.
- Cost per new patient by channel, and how it compares with previous months.
- What they changed this month, and what they plan to test next.
Impressions, rankings and clicks can sit underneath those numbers, but they shouldn’t replace them. Agencies sell; your job is to make them explain. For the rest of the growth topics, see the practice growth guides.