820 Patient Appointments at $13.74 Each — Local Chiropractic Clinic
$64 CPA. That's where this clinic was bleeding money. In 8 months, I rebuilt their Google Ads from the ground up — launching urgent 'Same Day Appointment' campaigns and layering in Performance Max — until we hit a $13.74 blended CPA and 820 appointments delivered in a single year.
Key Results
820
Appointments Generated
Real patient bookings across Search and Performance Max, Jan–Aug 2026
$13.74
Blended CPA
Down from a peak of $64.01 — a 78% cost reduction per appointment
$8.50
Performance Max CPA
Best-performing campaign — high volume, ultra-low cost per booking
The Challenge
What the client was dealing with
The clinic's traditional Search campaigns were getting increasingly expensive, with their core campaign peaking at a $64.01 CPA. They needed more patient volume — but throwing more budget at the same broken structure was out of the question. The local market was competitive and the account lacked the infrastructure to scale.
My Approach
What I actually did
- Launched a dedicated 'Same Day Appointments' Search campaign targeting urgent, high-intent searchers — driving leads as low as $15.35
- Deployed two complementary Performance Max campaigns to extend local reach across Google Maps, YouTube, and Display — achieving CPAs as low as $8.50
- Transitioned all campaigns to Maximize Conversions bidding, feeding the algorithm clean appointment booking data (not generic form fills)
- Built an aggressive negative keyword framework to block informational searches and protect every dollar for high-intent traffic only
The Numbers
Biggest Lesson Learned
“Performance Max surprised me here. I was skeptical about running PMax for a local clinic with a tiny budget, but the data proved me wrong — it consistently beat the Search campaigns on CPA. The lesson: don't let assumptions override testing. Let the data decide.”
Project Info
Industry
Healthcare & Local Services
Country
Canada
Duration
8 Months (Ongoing)
Budget Scale
$1.5k / Month
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