A Google Ads audit is a structured look at whether your account spends money on the right searches, counts the right results and belongs to you. This 30-point checklist takes about an hour with read access to your practice's account. Each check is tagged by severity, Fix now, This month or Nice to have, so you know where to start.
Owners ask about this more than you might think: "google ads audit" draws 210 US searches a month at $39.71 a click (Google Ads Keyword Planner data via DataForSEO, US, 12-month average to Sep 2026).
Make it a worksheet: copy this checklist into a spreadsheet and add a severity column and a notes column.
Before you start: access, ownership and billing
Ownership problems are rare but the most expensive to discover late.
- 1. The practice is an admin on its own account. Fix now. Only admins can grant access, change access levels and unlink manager accounts (access levels (opens in a new tab)).
- 2. Billing is in the practice's name, on the practice's card or invoice. Fix now. If an agency bills you for "media," ask what Google actually charged.
- 3. Agency access is standard or a manager-account link, both removable by your admin. This month.
- 4. Former staff and old agencies are removed. This month. Check the users list and linked manager accounts.
- 5. Change history shows regular work. This month. Google's change history (opens in a new tab) covers two years and names who made each change.
Who should hold the keys, and what your contract should say, is covered in who should own your ad accounts.
Conversion tracking checks
If tracking is wrong, every other number is too.
- 6. Each conversion action is something a new patient does: calls, appointment requests, booking clicks. Fix now. Page views don't count.
- 7. Lead actions count "One" per click, not "Every" (counting options (opens in a new tab)). Fix now.
- 8. No action is counted twice, for example by an Ads tag and an imported Analytics event. Fix now. Submit a test form and check it appears once.
- 9. Conversion names and thank-you URLs are neutral: no conditions or treatments. Fix now.
- 10. No ad tags fire on intake forms, patient portals or condition pages, and no form contents or hashed contact details go to Google without legal review. Fix now.
Setup details are in our conversion tracking setup guide.
Search terms and negative keyword checks
This is where most practice accounts leak money.
- 11. Read the last 30 days of search terms, sorted by cost. Fix now. Count how much went to irrelevant searches.
- 12. Job, school and training searches are blocked. Fix now. "Hiring," "jobs," "salary," "course."
- 13. Negatives include plurals and synonyms. This month. Google's negatives don't cover close variants.
- 14. No negative blocks your own keywords. This month. One stray "dental" negative can stop a dental campaign.
- 15. A shared list holds universal junk and is applied to every campaign. Nice to have.
Start from our negative keyword list if the account has none.
Campaign, location and schedule settings
- 16. Location option is "Presence," not the default "Presence or interest," which also reaches people who have only shown interest in your area (location options (opens in a new tab)). Fix now.
- 17. The targeted area matches how far patients travel for this service. This month.
- 18. Search partners and Display are deliberate choices. New Search campaigns include search partners by default (Search Network (opens in a new tab)). This month.
- 19. Ad schedule matches when you can answer the phone, if calls are a main conversion. This month.
- 20. Each ad group points to the page for its service, not the homepage. This month.
Ads, assets and policy status
- 21. No ads or assets are "Disapproved." Fix now. Google defines it as an ad that "cannot run because its content or its destination violates Google Ads policy" (ad statuses (opens in a new tab)).
- 22. Every "Eligible (limited)" status is understood. This month. It means the ad complies but is "limited in where and when" it can show, and healthcare is one of the policies that causes it (definition (opens in a new tab)).
- 23. No prescription drug terms appear in ads, keywords or landing pages unless you're certified. The Healthcare and medicines policy (opens in a new tab) restricts them (checked October 22, 2026). Fix now.
- 24. Each ad group has at least one current responsive search ad whose headlines match its keywords. This month.
- 25. Call assets are on and scheduled to office hours. Nice to have.
Budget, bids and pacing
- 26. Monthly spend matches what you expect. Google can spend up to twice your average daily budget in a day, and no more than 30.4 times it in a month (overdelivery (opens in a new tab)). Fix now if it doesn't.
- 27. Someone at the practice approves budget increases. This month.
- 28. The bid strategy fits your conversion volume. Google suggests judging Smart Bidding (opens in a new tab) over periods with at least 30 conversions; an account with a handful a month has little to learn from. This month.
- 29. Auto-apply recommendations are off, or reviewed. If on, Google can add broad match keywords, expand to search partners or change bid strategies (auto-apply (opens in a new tab)). Fix now.
- 30. Budget sits with the services that produce patients, not split evenly by habit. Nice to have.
More on monthly ceilings in budget pacing.
Turning Google Ads audit findings into a fix list
An audit is only useful if it ends in a short, ordered list.
- Copy every unchecked item into the sheet with its severity.
- Do "Fix now" items this week, in this order: ownership, tracking, wasted search terms, policy.
- Schedule "This month" items with a named owner and a date.
- Re-check in 30 days: did wasted spend drop, did conversions stay clean, did nothing new get disapproved?
- Decide who keeps it fixed. If the same items fail every quarter, the weekly routine isn't happening. Compare options in our guide to Google Ads management.
Two shortcuts. Medfy's free marketing audit scores six areas from 0 to 100 (website, SEO, Google listing, AI visibility, social and ads) and lists the top five fixes, using public information only. And if you use Medfy's Google Ads add-on, every change it makes is logged and can be undone, so the change history check above stays easy. For background on any check, see Google Ads for medical practices.
Frequently asked questions
How often should I audit my Google Ads account?
Run a full audit like this one every quarter, and after any big change: a new manager, a website redesign, a new service line or a jump in budget. Between audits, the weekly routine of checking search terms, spend and conversions catches most problems. If you've never audited the account, do it before adding a single dollar of budget.
What are the most common Google Ads mistakes practices make?
The usual ones are conversion tracking that double counts or doesn't work, location set to 'Presence or interest' so ads reach people outside the area, no negative keywords for job and school searches, ads sending everyone to the homepage, and auto-applied recommendations nobody reviewed. Ownership problems are rarer but costlier: if an agency holds the account, you lose its history when you leave.
Can I audit Google Ads without admin access?
Mostly. Read-only access lets you view campaigns, settings, users and reports, which covers nearly all of this checklist. What you can't do is change who has access or unlink a manager account; only admins can. If the practice isn't an admin on its own account, that is your first finding, and fixing it comes before everything else.
What does a Google Ads audit cost?
Doing it yourself with this checklist costs an hour or two. Agencies may offer a free audit as a sales step, which can be useful, but read it knowing who wrote it; independent consultants charge for a written review. Medfy's free AI marketing audit scores your ads alongside your website, SEO, Google listing, AI visibility and social presence, and lists the top fixes.