The brand had grown to 30 locations across the US Southwest, and its Google Ads account had grown with it without ever being restructured. What began as a handful of campaigns became a single account carrying a six-figure monthly budget, with every city and every service pushed into the same shared ad groups. An advert could show for the wrong treatment in the wrong market and nothing in the structure would catch it.

The waste was structural. With loose match types and no maintained negative keyword lists, a third of spend landed on irrelevant queries: searches the brand could never serve, in places it did not operate, for things it did not sell. Meanwhile the adverts themselves were generic, because ad groups mixing every theme cannot speak to any single search, and generic adverts earn fewer of the clicks that matter.

Worst of all, the account was optimising blind. Most dental patients book by phone or through an online form, yet there was no call tracking and no booking attribution, so Google's bidding never learned which clicks became patients. The team could report clicks and cost per click in detail, but the only question leadership cared about, which keywords actually produce a patient, had no answer.

We rebuilt the account from the ground up rather than patching it. The new structure gives each location its own campaigns, split by service line, so budgets, bids and ad copy answer to a single market and a single treatment. Ad groups were rebuilt around tightly themed keyword sets, negative keyword lists were reconstructed to keep irrelevant searches out, and every treatment gained a dedicated landing page that continues the conversation the advert started.

The measurement layer came next, because structure alone cannot fix an account that optimises toward the wrong outcome. Call tracking was wired in so phone bookings could be traced to the keyword and location that produced them, online-booking events were captured properly, and both were fed into Google Ads as offline conversion imports. From that point the bidding optimised toward booked appointments rather than clicks.

Finally we set an operating rhythm around the rebuilt account. Budgets are reallocated monthly using market-level cost per booking, so practices with headroom receive more spend and saturated markets give it up. Reporting moved to dashboards that show spend, bookings and cost per booking by location, which turned the monthly budget conversation from a defence of clicks into a review of patients.