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.
Three demand sources, and one of them is not on Google
Parents of 10 to 14 year olds search on brand and location, often after a general dentist says it is time. Adults searching clear aligners are shopping price, treatment length, and whether they have to wear something visible to work. Those two audiences need separate pages and separate ad copy, because almost nothing that persuades one persuades the other.
The third source is the referring general dentist, and for a lot of practices it is still the largest. Referral relationships are marketing work: a referral page a GP office can use, case updates that get back to the referring doctor, and a tracked line that tells you which offices send and which stopped.
Timing matters more here than in most healthcare categories. Start volume spikes in summer before school and again in December, when families have unused FSA dollars and met deductibles. Budget flat across twelve months and you underspend both peaks.