How we measure
Ten people filled out your form.
Nine of them have a story nobody told you.
Fifteen years in this business and nearly everything has changed. The platforms, the algorithms, what you are allowed to say, what you are allowed to track. One thing never has: the money comes from the patient who sat in the chair. What has changed is what anyone can tell you about the other nine. They are not a loss column. They are nine people at nine different points of a decision that takes months, and between your team and RootLogic every one of them has a state instead of a silence.
The nine and the one
The nine were never lost. They were unaccounted for.
A lead is a stranger who typed their name. Nothing has happened yet. Across this category ten inquiries turn into roughly four consultations and one procedure, and the other nine get quietly written into a loss column — because the reporting stops looking at them the day they do not book.
That is the error, and it is an expensive one. Nine people did not evaporate. One booked and has not come in yet. Two are mid-follow-up. One is waiting on financing. One went quiet in March and will surface in September, because this is a decision people take months to make. Calling that cohort waste is not measurement. It is giving up early and filing it as a result.
Our own figures are running totals, counted continuously rather than recalculated, so a number here only ever moves forward. The ten in today’s ratio are not a verdict on ten people. Several of them have not finished deciding, and when they do, the row moves.
Live from our own attribution system, refreshed weekly
- 8,159 tracked leads have produced 3,507 booked consultations and 979 completed procedures. Of every 10 leads, 4.3 reach a consultation and 1.2 reach a procedure, against an industry average of 1.
Leads
10
8,159 tracked
Consults
4.3
3,507 booked
Procedures
1.2
979 completed
Industry average
1
the same ten leads
The same ten inquiries. The category turns them into 1 procedure. Across the practices we run they become 1.2 — and because these are running totals rather than a monthly recount, that row is still moving.
Figures as of
The argument we stopped having
“You got the leads. It must be your staff.”
Every practice owner we meet has had some version of this conversation with an agency, and we have been in the room for it. It is unwinnable, because nobody in the room can tell the story of the nine.
The agency says
“We delivered 214 inquiries this month and the cost per inquiry is down. Whatever is going wrong is happening after we hand them over.”
The practice says
“My front desk worked every one of them. They were price shoppers, wrong numbers, and people who were never going to book anything.”
The story neither side could tell
- Which of those 214 were ever connected to a person.
- How long each of those calls actually lasted.
- Which ones were called back, how fast, and how many times.
- Which ones are still in follow-up right now, and which went quiet.
- Which ones reached a consultation, and which of those were kept.
- Which ones ended in a procedure the practice collected on.
This is not a personality problem and it is not solved by changing agencies. Six questions, none of them answerable, and a month of work disappears into an argument. The moment each of those inquiries carries its own state, the argument has nothing left to be about — and what usually surfaces is that both sides were partly right, which is the most useful thing a practice can learn in a month.
The standard
Published before you are a client, not after the first bad month.
A definition you can only see once you have signed is not a standard, it is a negotiating position. Here are ours. They are the same four on our results page, read from the same file, so they cannot say one thing there and another here.
- A qualified call
- Inbound, connected to a person, and at least sixty seconds long, with automated dialer bursts excluded. A phone system marking a call "completed" when it rang out to voicemail does not make it a lead.
- A consultation
- A real appointment that reached the calendar, tracked through to whether it was kept. Booked and showed are two different numbers and we report both.
- A procedure
- Confirmed by the practice, then attributed back to the campaign that produced the original inquiry. This is the number the whole system exists to move.
- Your ad account
- Yours. It is opened in the practice name, and the history stays with you the day you decide to work with somebody else.
These thresholds live in the reporting layer rather than in a spreadsheet or a slide, which is why the figure on this page, the figure on your own dashboard, and the figure we quote on a call are the same figure. Changing one of them is a change to the system, visible to you, not an edit somebody made to a report.
The definition, applied
What counts as a lead, and what only looks like one.
A lead is one prospective patient, making contact once, through something the marketing produced.
That sentence is the whole standard. Everything below is that sentence held against the traffic a real practice actually receives in a month, including the traffic that gets invoiced as a lead everywhere else in this category.
| What came in | Lead? | Why |
|---|---|---|
| A form filled out by a prospective patient | Counts | A name, a way to reach them, and an intent. This is the base case, and it is the only one most reporting bothers to measure. |
| The same person filling out the same form again on Thursday | Counts once | Same name, same practice, inside a seven-day window. One person is one lead. Counting the second submission is how a flat month turns into a good-looking report. |
| An inbound call that reached a person and ran past sixty seconds | Counts | Inbound, connected, sixty seconds or longer, with automated dialer bursts stripped out. Sixty seconds is roughly where “is this the hair place” ends and a conversation starts. |
| An inbound call that rang out to voicemail | No | Your phone system will mark that call “completed”. It was a missed call. It belongs on the answering report, where somebody can do something about it, not in the lead column. |
| A robocall. Then eleven more, from eleven different numbers, inside half an hour. | No | A burst of short calls from numbers that never call again is a dialer, not a patient. This is the single most common thing billed as a lead in elective healthcare. |
| A wrong number | No | A real human being who was trying to reach the pizza place. Six seconds, under the floor, gone. And no, we do not deliver. |
| A form fill whose name field is a URL offering you backlinks | No | Spam-shaped names, pitch keywords and long digit runs are flagged the night they arrive, before anyone on your team wastes a call on them. |
| An inquiry from forty miles outside your market | Counts | Patients travel for this work, routinely and across state lines. Distance is a targeting conversation to have with us. It is not a reason to delete somebody from your own record. |
| An inquiry from another country | Counts, if it is a person | Same rule, and we do not pretend otherwise: geography is not what disqualifies an inquiry here. Bot-shaped submissions are caught by the junk rules. A real person who is genuinely no use to your calendar is a targeting problem we owe you a fix for, not a number to quietly delete. |
| An Instagram or Messenger DM | Not yet | A DM is a conversation, not an inquiry, and DM volume has been inflating this category for years. If that same conversation later reaches a consultation it counts retroactively, back to the day it arrived. |
| A contact your front desk typed in after a walk-in | No | A real patient and a real record. The marketing did not produce it, so it does not go in the marketing column. Nobody should be paid for your reputation. |
| The caller who searched “hair surgeon near me”, clicked, and wanted to know whether rosemary oil regrows hair | Counts as a lead. Never as a consultation. | Real person, real click, real ninety-second call. Under any honest definition that is a qualified lead, and it is worth precisely nothing to your surgery day. We publish it rather than filter it, because this row is the entire argument for judging us at the consultation and the procedure instead. |
Six of those twelve are counted somewhere in this industry as a lead you paid for. The one at the bottom is counted everywhere, including here, and it is the reason the lead number is the worst number in your report to be judged on.
Where the nine actually go
Between your team and RootLogic, the nine keep moving.
Publishing a definition raises the obvious question: what happens to everyone who does not clear it this month? On most engagements the answer is nothing, because nobody knows who they are any more. The inquiry came in, somebody called it once, and it left the record.
RootLogic, our offline conversion tracking, is where that stops. Every inquiry enters carrying its source, its campaign and its click, and then carries a state for as long as it takes: contacted, booked, showed, went quiet, reactivated. Follow-up cadences run against that state rather than against a list somebody remembered to work. Reminders protect the consultations already on the calendar, and an inquiry that paused in the spring is still reachable in the fall, because it never fell off the board.
The other half is your team, and it is the half nobody sells. RootPlayBook is the training library your staff logs into — phone handling, objection handling, follow-up that does not quit after one voicemail, photography and video for your own channels, review generation. It is taught against your practice’s own numbers rather than a demo account, because staff will argue with a benchmark and they will not argue with last Tuesday. It is the least glamorous half of this business and it moves the number further than any bid adjustment we have ever made.
The first sixty seconds
Most of what the campaign paid for is decided on the opening call. That call is trainable, and we train it.
Follow-up that outlasts the month
Speed to first contact, then persistence past the first attempt. Both are the cheapest improvements available, because the inquiries are already paid for.
The ones who come back
People pause for money, timing, or a spouse. An inquiry that went quiet keeps its state and its source, so a reactivation months later is still attributed to the campaign that produced it.
What the AI is for
The standard holds itself up.
A definition is only worth something if something checks it every day, on every call, without anyone having to remember to. That is the job we gave the automation, and it is the only job we gave it.
01
Every call, scored against the same rule
Inbound, connected to a person, past the sixty-second floor, with automated dialer bursts stripped out. No one has to listen to a recording to find out whether a month was real.
02
Outcomes sent back to the platforms
Confirmed consultations and completed procedures are uploaded as the conversion signal, so the bidding learns from patients instead of from form fills. The algorithm optimizes toward the thing you actually wanted.
03
The gaps surface as work
The inquiry nobody called back. The one that has been in follow-up too long with nothing moving. The keyword that has spent for a quarter and never produced a procedure. Each one arrives as a task with a name on it.
What that buys a surgeon is not a better report. It is the ability to stop reading them, so the attention goes back to the procedures and the calendar.
Questions
Asked on nearly every first call.
- What is the definition of a lead?
- A lead is one prospective patient, making contact once, through something the marketing produced. In practice that means a form submission from a real prospective patient, or an inbound call that connected to a person and lasted at least sixty seconds with automated dialer bursts excluded. One person contacting you twice in a week is one lead, not two.
- Do robocalls count as leads?
- No. A burst of short calls from numbers that never call again is an automated dialer, and it is excluded before the number reaches your report. Robocalls invoiced as leads are the most common padding in elective healthcare reporting.
- Does a wrong number count as a lead?
- No. A wrong number is a real person who wanted somebody else, and the call ends in seconds, which puts it under the sixty-second floor. It never becomes a lead, and it never reaches an invoice.
- Does an out-of-area or out-of-country inquiry count as a lead?
- Yes, if it came from a real person. Geography does not disqualify an inquiry, because patients travel for elective procedures routinely and across state lines. If a market is producing inquiries your practice genuinely cannot serve, that is a targeting problem for us to fix in the campaign, not a row to delete from your record.
- What is the difference between a lead and a consultation?
- A lead is a first contact. A consultation is a real appointment that reached the calendar, tracked through to whether it was kept, because booked and showed are two different numbers and both get reported. A procedure is confirmed by the practice and attributed back to the campaign that produced the original inquiry.
- What counts as a qualified lead?
- An inbound call that connected to a person and lasted at least sixty seconds, with automated dialer bursts excluded, or a form submission from a real prospective patient. A phone system marking a call “completed” when it rang out to voicemail does not make it a lead.
- What happens to the inquiries that do not book?
- They keep a state rather than leaving the record. Each one holds its source, its campaign and where it stopped, so follow-up continues on a cadence instead of on whoever remembered, and an inquiry that went quiet months ago is still reachable and still attributed when it comes back. In an elective practice the decision routinely takes longer than the reporting month it arrived in.
- Why measure procedures instead of cost per lead?
- Because a practice is paid for procedures. Cost per lead can improve while revenue falls, and routinely does: cheaper inquiries are usually less qualified ones. Measuring at the procedure keeps the two numbers from drifting apart without anybody noticing.
- Who decides whether a procedure happened?
- The practice does. A procedure is confirmed by your team and then attributed back to the campaign that produced the original inquiry. We never mark one ourselves, and we never infer one from a lead source.
- What happens when the numbers are bad?
- You see them at the same time we do, on the same screen, and the conversation becomes which part of the path is leaking rather than whose fault it is. Where the leak is operational, the training library and the consulting are already part of the engagement.
- Do we own the ad account and the data?
- Yes. The account is opened in the practice name, the campaign history is yours from day one, and it stays yours on the day you decide to work with somebody else.
Ask us what your nine are actually worth.
The Growth Audit reads your market, your competitors and your current acquisition path, then comes back with the volume math from inquiries through to procedures for your own practice — including what is still sitting unworked in the inquiries you have already paid for. It takes us about a week.
As of 12 September 2026, Vitality client practices have produced 8,159 tracked leads, 3,507 booked consultations and 979 completed procedures — a ratio of 10 : 4.3 : 1.2 against a category average of 10 : 4 : 1.