Turning Marketing Spend Into Patient Volume

Featuring Dylan Marchese & Trevor Johnson

Ask most chiropractic practice owners why they’re hesitant to spend more on marketing, and you won’t get a strategic answer — you’ll get a scar. We brought on Dylan Marchese and Trevor Johnson, who run a marketing agency built specifically around chiropractic clinics, to talk about why that trust gets broken so often, and what it actually takes to turn ad spend into a predictable stream of new patients.

Why chiropractors get burned

The stat Dylan and Trevor shared stopped us in our tracks: the average agency-client relationship in this space lasts about three to six months. The typical clinic that ends up working with them has already cycled through five to seven other marketing providers.

Part of that comes down to a genuinely young, low-barrier-to-entry industry attracting agencies chasing quick growth for themselves rather than results for their clients. But part of it is also on the clinic side — decisions about marketing often get made on feel rather than data. “I think this campaign is working” or “the leads feel low quality lately” are common refrains that, when you actually pull the numbers, frequently turn out to be wrong.

The four numbers that actually matter

Instead of fixating on cost-per-lead — which Dylan calls a classic vanity metric —Trevor and Dylan build everything around four figures: lead volume, booking percentage, show percentage, and conversion percentage. Together, those four roll up into the number that actually matters: return on investment.

Ahigh cost-per-lead isn’t automatically bad, and a low one isn’t automatically good. If you’re seeing a 5x return, a $60 lead is a great lead. Chase the cost down to $20 without understanding why it dropped, and you may just be buying worse-qualified leads — and watching your actual return shrink in the process.

What should you actually be spending?

There’s no single right number, but Trevor offered some real benchmarks: a reasonable starting point is around 8% of gross revenue on marketing, with strong-performing clinics scaling up to 15%, and some pushing 20–25% because the return justifies it. On a dollar basis, a realistic floor for a serious digital marketing effort — agency fees and ad spend combined — is around$3,000/month, with established clinics investing $10,000+ once you factor in website, SEO, and the newer world of AI-search optimization.

How fast you see a return depends heavily on your province and billing model. In care-plan provinces like Alberta and Ontario, clinics often see ROI within the first month. In pay-per-visit markets like BC, the return builds more gradually as patients stay on care over time — but it still adds up, especially once referrals and family members enter the picture.

The mistakes that hold clinics back

A few patterns came up again and again in the conversation:

Flying blind. Clinics that can’t answer basic questions —how many new patients came from the website last month, what their actual conversion rate looks like — are the ones most likely to make expensive, emotional decisions about their marketing.

Betting everything on one channel. Dylan and Trevor described clinics generating 100% of new patients from paid ads with zero presence on Google or other organic channels — a fragile setup that leaves a practice exposed the moment ad costs rise or a platform changes its algorithm.

Chasing the cheapest option. A $1,000 website that never converts a single new patient is worse than a properly built one that costs more but consistently brings in new business.

Half-hearted participation. The clinics that get the best results are the ones that treat their agency as a genuine partner — sending fresh photo and video content regularly, staying responsive, and treating marketing as an ongoing collaboration rather than a bill they set and forget.

Where the real ROI compounds

The clinics seeing the strongest long-term results, according to Dylan and Trevor, aren’t necessarily spending the most — they’re the ones with strong fundamentals already in place. Great clinical care, solid intake and case-presentation processes, and high patient retention mean that every new patient a marketing dollar brings in is worth dramatically more over time, through repeat visits, longer care plans, and referred family members.

As Trevor put it: the more you can make from a patient, the more you can afford to pay toacquire one. Marketing doesn’t fix a leaky bucket — it just fills it faster.

Curious how your own marketing numbers stack up? [Listen to episode 041 of The Chiro Money Show →]

‍