Questions to ask a marketing agency before you sign

Questions about results and proof

• 1. Which practices like ours have you worked with, and can I call two of them? Good answer: named practices of your specialty and size, with permission to call.
• 2. What results did they get, and how did you measure them? Good answer: calls, forms and new patients by source, not impressions or "reach".
• 3. Can I see a real monthly report with client details removed? Good answer: yes, today, and it shows what changed and why.
• 4. Tell me about a client where something didn't work. What did you change? Good answer: a specific story, a change and an outcome.

Questions about who does the work

• 5. Who exactly will work on our account? Good answer: names and roles, including who does the hands-on work, not only the account manager.
• 6. What do you outsource or white-label? Good answer: a straight list, and those subcontractors are covered by your BAA if they touch patient information.
• 7. How many accounts does our account manager handle? Good answer: a number, plus a named backup for holidays.

Questions about ownership of your accounts and website

• 8. Will our domain stay registered in our name, in our own registrar account? Good answer: yes, and you'll never need the agency's permission to move it.
• 9. If we leave, do we keep the website: content, images and code? Good answer: yes, with a handover on a stated timeline.
• 10. Will the practice hold the owner role on our Google Business Profile? Good answer: yes; the agency takes manager access. Google says only owners can add or remove users (opens in a new tab).
• 11. Are the Google Ads, Meta ad and Google Analytics accounts in our name, with admin access for us? Good answer: yes, and the agency works through user or partner access.

Questions about HIPAA, BAAs and tracking

• 12. Will you sign a BAA? Good answer: yes, before any patient information flows, if they host forms, run a CRM or handle call recordings. Under HIPAA, a vendor that creates, receives, maintains or transmits protected health information for you is a business associate (opens in a new tab). Our BAA basics explain what it must cover.
• 13. Do you place tracking pixels on pages with forms? Good answer: no, never on pages where patients enter health information. On June 20, 2024, a federal court vacated one part (opens in a new tab) of HHS's tracking-technologies bulletin, the part about public pages, and said the rest was not limited. Google says it doesn't offer a BAA for Google Analytics (opens in a new tab). Read more on pixels on form pages.
• 14. Where are form submissions and call recordings stored, and who can see them? Good answer: a named HIPAA-compliant system under a BAA, with access limited by role, not a shared inbox.
• 15. Will you ever upload patient lists to ad platforms? Good answer: no. Marketing use of patient information generally needs each patient's written authorization (opens in a new tab).

Questions about fees and ad spend

• 16. Is your fee a flat management fee or a percentage of ad spend? Good answer: a clear model, in writing, with the scope it buys.
• 17. Is ad spend billed by Google and Meta directly, or passed through your invoice with a markup? Good answer: billed directly to the practice's card, or any markup stated as a number.
• 18. What does the setup fee cover, and what costs extra? Good answer: a list, including landing pages, photography and extra pages.
• 19. What happens to your fee if we raise or cut the ad budget? Good answer: a straight explanation, and no penalty for cutting spend.

Questions about reporting and meetings

• 20. What will the monthly report show? Good answer: calls, forms and booking clicks by source, cost per lead, what changed and next steps.
• 21. Will we have live access to the ad accounts and analytics, not only PDFs? Good answer: yes, from day one.
• 22. Do you keep a log of every change made to our ads? Good answer: yes, dated, with who made it and why.

Questions about contract length and leaving

• 23. What is the term, and does it renew automatically? Good answer: a short initial term, renewal only with notice, and a notice period you can live with.
• 24. What does it cost to leave early? Good answer: a small, stated fee or none, not the rest of the contract's value.
• 25. When we leave, what do we get back and how fast? Good answer: logins, website files, data exports and the return or destruction of patient data, within a set number of days. Check the wording against our contract clauses to check.

Answers that should worry you

• "We'll set up the ad account under our agency so we can manage it more easily."
• "Our pricing includes your ad spend," with no line showing what Google or Meta actually charged.
• "You'll be on page one within 90 days," or a promised number of new patients.
• "We don't need a BAA; we're a marketing company," from an agency that will read your form submissions.
• "The pixel needs to be on every page, including the forms."
• "We own the website design; you license it while you're a client."
• "Reports are monthly PDFs," with no live access.

If you're weighing whether to use an agency at all, compare it with a hire, a freelancer or a platform in agency or in-house. Running paid ads only? Our page with questions for ad agencies adds the policy and tracking checks.

Frequently asked questions

What should I ask a marketing agency before hiring it?

Cover seven areas: results from practices like yours, who will do the work, who owns your accounts and website, HIPAA (a BAA, pixels on form pages, where form data lives), fees and how ad spend is billed, what reports and meetings you get, and the contract term and exit. The 25 questions on this page cover each area with what a good answer sounds like.

How do I know if a healthcare marketing agency is good?

A good agency shows results from practices like yours in terms you can check, such as calls, forms and new patients by source, and lets you call those clients. It keeps every account in your name, signs a BAA when it handles patient information, keeps pixels off form pages, bills ad spend transparently and explains how you leave without losing anything.

What are red flags in a marketing agency?

Accounts or the domain registered in the agency's name, ad spend billed through the agency with no access to Google's or Meta's invoices, promises of rankings or patient numbers, refusal to sign a BAA while handling patient data, pixels on intake forms, reports limited to impressions and clicks, and long contracts that auto-renew with no exit terms for your website and data.

Should a marketing agency guarantee results?

No, and be wary of one that does. No agency controls Google's rankings, what AI assistants recommend or how many patients call. What an agency can commit to is work: tasks completed each month, response times, reporting and transparency about spend. Ask for those commitments in writing, plus a clear exit if the agreed work isn't delivered.