Most clinics in Vancouver are running Google Ads. Most of those clinics are losing money on Google Ads. The five mistakes below cover almost every account we audit. None of them are exotic. All of them quietly compound until the spend stops looking like marketing and starts looking like a tax.
Here is what to check before you put another dollar through the platform.
1. Broad-match keywords with no negative list
Google’s default match type is now broad. That means a bid on “physiotherapy Vancouver” quietly shows your ad on searches for “physiotherapy school Vancouver”, “free physiotherapy classes”, “physiotherapy career change”, and dozens of other phrases that have nothing to do with booking a patient.
You will not notice this in the dashboard. You will notice it in the credit-card bill.
The fix has three parts. First, run your search-terms report for the last 90 days and read every query that triggered an impression. You will be surprised at what is in there. Second, add a negative-keyword list for the obvious wasters: free, jobs, school, training, near me jobs, salary, classes, certification. Third, switch your most expensive keywords from broad to phrase or exact match.
A clinic running $4,000 a month on broad match with no negative list typically wastes $800 to $1,200 of that on irrelevant searches. Fixing this is the highest-ROI thing you will do on the account.
2. Sending ad traffic to the homepage
A homepage is built to introduce the clinic to anyone. An ad clicker is not anyone. They typed a specific query, clicked a specific ad, and arrived expecting a specific answer.
If somebody searches “pelvic floor physiotherapist Vancouver”, clicks an ad, and lands on a homepage that talks about your team, your locations, and your full service menu, you have just given them homework. Most people will not do it.
The fix is one landing page per ad group, mapped to the search intent. “Pelvic floor physio Vancouver” lands on a page that talks about pelvic-floor physiotherapy, the practitioner who provides it, what to expect at the first visit, the booking link, and nothing else. Removing the nav bar removes the temptation to wander.
Conversion rates on a focused landing page are typically two to four times higher than on a homepage. Same traffic, same spend, more booked patients. We cover this more fully in our landing pages capability page.
3. Not tracking phone conversions
This is the most expensive mistake in the list because it makes every other decision worse.
Most clinic patients still call. Especially older cohorts. Especially for specialty services with long consideration windows like naturopath, pelvic-floor physio, and mental health. If your Google Ads dashboard only counts form fills, you are systematically under-counting the conversions you are actually paying for, and the platform is optimizing against a wrong signal.
The fix is to set up call tracking with a dedicated forwarding number on every ad, fire a conversion event into Google Ads when the call lasts longer than 60 seconds (long enough to be a real inquiry), and feed booked-call data back into the account.
The first time a clinic does this, the cost per conversion typically drops by 30 to 50 percent on the dashboard. Not because conversions changed, but because they were happening all along and the platform finally sees them. Then the bidding algorithm starts making better decisions because it is finally optimizing against reality.
4. Optimising for clicks instead of booked patients
A click is not a patient. A form fill is not a patient. Even a phone call is not always a patient. A booked, paid, showed-up appointment is a patient.
Clinics that optimize their Ads against clicks or impressions get cheaper clicks and more leads. Both numbers go up. Booked patients do not. Sometimes booked patients go down because the cheap traffic the algorithm starts buying is even less qualified than what you had before.
The fix is to wire booked-appointment data back into Google Ads as the optimization target. If your booking platform is Jane App, Cliniko, or Juvonno, this means tagging the booking-confirmation page or piping booking events through Google Tag Manager into the Ads account. Then you change your bid strategy to Maximize Conversions or Target CPA against the booked-patient event, not against form fills.
This is the entire reason lead quality matters more than lead volume. The platform optimizes against whatever signal you give it. Give it a soft signal, get soft outcomes.
5. Letting Google’s auto-bidding pick the goal
Google’s automated bidding strategies are good. They are also default-aggressive. If you switch to Maximize Conversions without setting a conversion value or a target CPA, the algorithm spends faster and chases volume.
This is how clinics end up with a daily spend that triples in two weeks while the booked-patient count stays flat.
The fix is to set guardrails. Use Maximize Conversions only after you have at least 30 days of booked-patient conversion data in the account. Use Target CPA once you know your acceptable cost per booked patient (covered in detail in our PAC framework article). Set daily budget caps that match your monthly budget divided by 30, not divided by 7. Do not let the auto-bidder pick goals you have not chosen.
What good looks like
A Google Ads account for a Vancouver clinic that is set up correctly has all five of these in place:
- Negative-keyword list reviewed monthly, search terms checked weekly
- One landing page per ad group, mapped to the search intent
- Call tracking active, calls longer than 60 seconds firing as conversions
- Booked-appointment data piped back into Ads as the optimization signal
- Bidding strategy set to Target CPA against a real, defensible cost-per-booked-patient number
A clinic running those five basics on $3,000 a month will out-perform a clinic running $8,000 a month without them. The difference is not the spend. The difference is whether the spend is buying patients or buying clicks.
If you want a second opinion on what your current Google Ads account is producing, the Clinic Growth Review surfaces the five points above and three more, on your real account, with your real numbers.