A med spa owner asked us last week how to spot agencies that ghost after month one. The ones that show up to the sales call sharp, sign you up, hit the numbers in month 1, then mysteriously underperform from month 3 onwards.
We told her: forget their case studies. Ask these 3 questions.
Most med spas pick a marketing partner by looking at the numbers someone else got. That's how they get burned twice. Numbers tell you what happened once. Questions tell you if it'll happen for you.
Here are the 3.
Question 1: "What happens between the form and the chair?"
Most agencies count leads. They send you a monthly report with "we generated 87 leads this month" and call it a win.
The money isn't in the leads. The money is made in the 5 minutes after someone fills the form.
Ask the agency exactly what happens when a patient submits a form on Tuesday at 8:47pm:
- Does an automated SMS go out within 30 seconds?
- Does a real human call back within 2 hours?
- Is there a 5-day text sequence chasing the ghosts who don't respond?
If the answer is "we hand off the leads to your front desk and they take it from there" — that's not a system. That's lead generation, and lead generation without follow-up is half the bucket leaking out the bottom while the agency keeps pouring water in.
The 5 minutes after a form fill is where the money lives. Speed-to-lead. SMS pulling back ghosts. Humans calling within minutes. Without those, leads die before they ever book.
If the agency you're talking to doesn't run the follow-up, they're not partners. They're a vendor selling traffic. Book a free audit and we'll show you the difference live.
Question 2: "Do you count appointments, or who actually walks in?"
The industry counts "booked appointments." That's how the case study slides get to "127 appointments generated."
Half of those no-show. Maybe more.
The number that pays your rent is the walk-in rate. The patient who actually showed up, sat in your chair, and gave you the chance to close them.
Ask any agency: "What's the walk-in rate on the appointments your campaigns produce?" If they don't have an answer, they're not tracking it. If they're not tracking it, they're running traffic — not a system.
Why does this matter? Because if 100 form fills produce 50 booked appointments and 18 actual walk-ins, your real cost-per-patient-in-the-chair is 5× higher than the cost-per-lead the agency reports. They've handed you a number that looks great on paper and means nothing in your bank account.
The fix is reminders, confirmations, and a no-show recovery system. Most agencies don't run this because it's annoying, manual, and not glamorous. The ones who do run it have walk-in rates of 65-85%, not 30-40%. That's not a tweak. That's the difference between a $40 cost-per-patient and a $120 one.
Question 3: "After the first month, who actually runs my account?"
This is the one most agencies hate.
Senior rep for month 1. The good talker. The one who knows your industry, knows your offer, knows how to run the case-study language. He hooks you, you sign, the contract is locked in.
Then the swap happens. Month 2 or 3, you get assigned to a junior. The senior rep is closing the next deal. The junior is running 8 accounts at once with 18 months of experience. Results dip. You don't know why.
Ask point blank: "After the first month, who actually runs my account day-to-day? Send me their LinkedIn."
If the answer is hesitant, evasive, or "we have a team that handles accounts" — you're about to get bait-and-switched. The senior rep landed you. The junior will run you into the ground over months 3-12 while the agency collects retainers.
The senior rep should run your account in month 3. And month 6. And month 12. If the founder doesn't have hands on the work, the work doesn't matter.
Originally posted on LinkedIn — and yes, we run our own clients. The same person on month 1 runs month 12. We can't scale to 200 clients that way and we don't want to.
What "Yes" to All Three Gets You in 5 Weeks
A med spa we work with said this 5 weeks in:
"I cannot grow anymore. I need a second location."
Here's what was on her dashboard at week 5:
- 195 leads
- 109 appointments
- 56 patients in the chair
- 45.20× ROAS
The bottleneck moved. From marketing to capacity. That's the goal — produce more demand than current operations can absorb, then decide on purpose: hire, expand, raise prices, open a second location.
She didn't get there because we showed her case studies. She got there because the system around the spend was tight on all three fronts: form-to-chair follow-up, walk-in rate management, senior eyes on the account every week.
What Case Studies Won't Tell You
Case studies are post-hoc. They show the result, not the process.
A 30× ROAS case study on someone else's account doesn't mean you'll get 30× ROAS on yours. It means in one specific market, with one specific offer, with one specific operations team, the system produced a result. Yours might produce 10×. Or 50×. Or zero.
What predicts your result is the system. Not the screenshot.
Hire the system. Not the case study.
30-Second Audit
Before you sign with anyone — including us — answer these three:
- Does the agency run the follow-up between the form and the chair, or do they hand the lead to your front desk and walk away?
- Do they track and report walk-in rate (not just appointments booked)?
- Will the same person who pitched you in month 1 still be running your account in month 6?
If any answer was "no" or "I'm not sure," book a free audit — we'll show you what each of these looks like in a real account, and you can use that as the bar for whoever you end up hiring. Even if you don't hire us, you'll know what good looks like.
Hire the system. Not the case study.