What £434 of advertising did to one clinic's diary, and then to its bank account.
Elite Therapy Clinic, a private physiotherapy, sports massage, cupping and rehabilitation practice on Hagley Road in Birmingham. Named here with the owner's permission, so you can look at the clinic and judge whether the numbers are plausible. Thirty-one days, read from the live Google Ads account and from the clinic's own practice-management system. Read it the way you would read a treatment note: what was done, what changed, what is claimed, and what is deliberately not.
The whole chain, 5 July to 4 August 2026
Advertising spend
£434.14
Appointments booked
54
Recorded as attended, a 95% arrival rate
41 of 43
New patient records created
28
Cost per new patient
£15.50
Collected from those patients, at least
£1,415
Invoices outstanding at period end
£0
Spend is from the Google Ads account. Every row beneath it is from the clinic's practice-management system, where an appointment has to exist for a patient to be seen and an invoice has to be raised for money to be taken. Every invoice raised in the period was paid in full, none outstanding. The collected figure is marked "at least" deliberately: this clinic does not put every transaction through the system, so the true number is higher than the one we are willing to print.
Against the 31 days before it
Jun–Jul
Jul–Aug
New patients
16
28
Cost per new patient
£18.37
£15.50
Appointments booked
35
54
Collected from new patients
£1,130
£1,415
And the one that moved the wrong way
Average collected per new patient
£70.62
£50.54
More new patients, each worth less on first contact. That is what scaling a cheaper enquiry does, and it is the number the next quarter of work has to fix. An agency that only showed you the four rows above would not have told you this.
The owner, in his own words
“I’ve tried other agencies and it just wasn’t the right fit. Faz has absolutely smashed it out of the park. He’s increased my Google presence, doubled my reviews since we started, and smashed every target we set.”
Bilal Hussain
Owner, Elite Therapy Clinic, Birmingham
Recorded unscripted and published with his permission. “Doubled my reviews” is his phrasing and stays inside his quotation marks: the figure we can evidence is the 18 to 45 above, read from the public profile.
Bilal Hussain, owner of Elite Therapy Clinic. 55 seconds. Nothing downloads until you press play.
The other thing an audit finds
At a second clinic, we found 77 bookings its dashboard had never shown anyone.
The account read like a failure: £38 a conversion, 24 conversions tracked. The booking system told the truth: 101 appointments and 94 new patients in the same month. The tracking was under-reporting by four times, and the owner had been judging the spend, and very nearly cutting it, on a number that was wrong by 77 bookings.
Finding that took an afternoon against the booking system. It is the first thing the £295 diagnostic checks, because until the measuring is honest, every marketing decision, ours included, is a guess.
What we refuse to claim
Judge an agency by the numbers it will not show you.
You will see agencies quote 10x returns to clinics every week. Ask where the number comes from. If the answer is "the ads platform", it is marketing about marketing.
Not the multiple the ads platform reports
Google reports a 14.9x return on this account. We will not print it, because that value is assigned inside the ads platform rather than taken from anyone's books. The roughly 3.3x you can work out from the rows above is a different thing entirely: it comes from invoices the clinic actually raised and was actually paid.
Not an attribution split we cannot evidence
Google recorded 116 ad conversions in this period. The booking system recorded 54 appointments. Platforms miscount, so we report the bookings and ignore the 116. Nor is every new patient from the advertising, since the clinic also takes referrals and walk-ins. We publish the whole new-patient cohort rather than invent a split that flatters us.
Not even the direction of the error
At this clinic the ads platform over-reported roughly two to one. At the second clinic above, the same platform under-reported four to one. Same platform, opposite error, which is why every number we publish is read from the booking system rather than the dashboard.
No credit for momentum we inherited
This clinic was already growing before the engagement. Gains that predate our involvement, like its spring rise in profile traffic, are stated as such and never claimed.
No mocked-up dashboards
Nothing designed will ever be presented here as a screenshot of a real account. What you saw above is what the accounts say.
Local search presence
84
134
June
July
Business profile interactions, June against July 2026, a 60% step. A separate measure on a separate period from the figures above, and shown that way deliberately. The clinic's earlier growth through the spring predates our involvement and is not claimed. Only this step is ours.
Reputation
18 → 45public Google reviews
Documented at engagement start and read from the public profile on 3 August 2026. The rating held at 5.0 across all 45 while volume grew, through a review workflow the clinicians actually use.
Two of the 43 appointments in the period were recorded as did-not-arrive. Attendance is a marketing number, and we report it like one.
What we publish next
One clinic is a case study, not a pattern.
This is one clinic over two months, and you should read it as exactly that. What it does not yet show is treatment-plan completion and what a patient is worth over a year rather than on first contact, which is the measure that decides whether any of this was worth doing. That work is underway with this clinic and will be published here in the same format, including the parts that do not flatter us.
This is also the standard you should hold anyone quoting you a monthly fee to. If an agency cannot show you the row where the money lands, they are asking you to take the first four rows on trust. In the meantime, we will happily put you on the phone with a current client.