A consult request is not a case
Because the exam is free, the barrier to requesting one is near zero. Say the report shows 60 consult requests. The schedule shows 22 kept appointments and 9 signed cases. The agency reports 60. The practice banked 9.
Every step in between is measurable and most practices measure none of it. Request to booked appointment. Booked to kept. Kept to same-day start. Same-day to signed within 30 days. Once those four numbers exist, you can tell whether the problem is the campaign, the reminder sequence, or the treatment coordinator.
The gap between request and kept appointment is usually the cheapest thing to fix, and closing it costs no additional ad spend. That is not a marketing win we get to brag about. It is still the first move.