The complete engagement

Everything We Ship, In the Order It Has to Ship

Two engines and ten phases, built for health and wellness practices and run in a fixed sequence, because the sequence is the part most campaigns get wrong. Content cannot rank on a site crawlers cannot read. A map pack cannot move while your name, address, and phone disagree across three systems.

Every campaign starts here. The scan is free and the chart is yours either way.

What we engineer to

These are build targets, not results we are claiming on anyone's behalf. The right-hand column is what we typically measure on the practice sites we audit before we touch them.

Time to first byte

Under 200ms

Commonly measured: 600 to 1200ms

Largest contentful paint

Under 2.0s

Commonly measured: 3.5 to 6.0s

Interaction to next paint

Under 200ms

Commonly measured: Over 400ms

Cumulative layout shift

Under 0.1

Commonly measured: Frequent failures

JavaScript shipped

Under 100KB

Commonly measured: 400 to 800KB

Accessibility standard

WCAG 2.2 AA

Commonly measured: Overlay widget

Two engines, one campaign

The Build makes the asset. The Domination compounds it. Practices that buy only the first get a beautiful site nobody finds. Practices that buy only the second pour traffic into something that cannot convert it.

Engine 01

The Build

The site, the booking path, the compliance spine

A custom-coded practice site engineered around one question: can a patient who is ready to book actually book. Speed, accessibility, structured data, and HIPAA-aware tracking are built in from the first commit rather than retrofitted after a report flags them.

  • Custom build, no shared theme
  • Booking path as the primary structure
  • WCAG 2.2 AA from the first commit
  • HIPAA-aware tracking architecture
Engine 02

The Domination

The surfaces that accumulate while you treat patients

Local search, AI answer engines, voice, treatment content, reviews, and citations, worked continuously so the results build on each other. This is the half that keeps producing after the build is finished, and it is the half most agencies stop doing in month four.

  • Map pack and geo-grid tracking
  • AI citation and entity work
  • Treatment and condition clusters
  • Reviews, citations, and digital PR

The sequence

Ten phases, run in this order

Mapped onto the same arc you use with a patient: diagnose, prescribe, treat, measure. The order is the method.

Phase 00Diagnose

Full diagnostic and market read

Before anything is proposed, we establish what is actually true about your visibility, your site, and your market.

  • Technical and content audit. Crawl access, indexation, speed, structured data, and the state of every page that currently earns anything

  • Local surface read. Google Business Profile completeness, category strategy, review volume and recency, citation consistency, and geo-grid rank across your real catchment rather than one check from your own office

  • AI visibility baseline. Whether ChatGPT, Gemini, Perplexity, and AI Overviews name your practice today, and who they name instead

  • Competitive gap analysis. The treatments, questions, and neighbourhoods your competitors answer and you do not

  • Compliance baseline. Tracking on intake pages, accessibility failures, claim language, and any state board disclosure your market requires

Phase 01Prescribe

The protocol, written for your market

A plan with named priorities and named numbers, agreed before work starts. Not a package with your logo on it.

  • Priority sequence. What gets fixed first, second, and third, ordered by what changes patient volume rather than what is easiest to report on

  • KPI agreement. The numbers we will be judged on, defined before we start so nobody redefines success in month six

  • Service and market scope. Which treatments and which neighbourhoods the campaign targets, based on verified demand rather than a keyword list

  • What we are not doing. Named explicitly, so the plan has edges and the budget is not spread across everything at once

Phase 02Treat

The build

A custom site engineered around the booking path, with speed, accessibility, and compliance as build constraints rather than later fixes.

  • Custom architecture. Server-rendered so your content is in the HTML on first fetch, which is the only version AI crawlers read

  • Booking as the spine. Online scheduling wired to your practice management system, click to call on every screen, and a form for patients who will not do either

  • Treatment page system. One page per treatment, structured to answer cost, candidacy, downtime, and what happens on the day

  • Provider pages. Named clinicians with credentials, certifications, and the specialty detail that decides whether a page is trusted

  • Accessibility built in. WCAG 2.2 AA in the markup itself. No overlay widget, which plaintiff firms now treat as a signal worth investigating rather than a defence

  • HIPAA-aware tracking. Advertising tags kept off intake, booking, and portal pages, consent gating everywhere else, and conversion measurement that does not depend on them

Phase 03Treat

Structured data and the entity graph

The machine-readable version of your practice, generated from one source of truth so it cannot drift.

  • Clinical business types. MedicalClinic, Physician, Dentist, and the specialty subtypes rather than a generic LocalBusiness, so Google knows which category of near me search you belong in

  • Complete location data. Address, coordinates, opening hours, telephone, service area, and accepted insurance where it applies, on every location

  • Provider entities. Each clinician as a Person or Physician node with credentials, specialty, and links to their professional profiles

  • Services and procedures. Your treatment list as structured offerings rather than prose a machine has to interpret

  • One source of truth. Every schema field generated from the same data as the visible page, so the two can never disagree

Phase 04Treat

Answer and generative engine optimization

Being the source an AI engine quotes, which is a different job from ranking and is increasingly the one that matters first.

  • Crawler access, agent by agent. The AI citation agents explicitly allowed, the training agents set to whatever you decide. Most sites conflate the two and lose the citations while trying to protect the content

  • Answer-first structure. Every treatment and condition page opens with the citable factual answer, then earns the rest of the read

  • Content in the initial HTML. AI crawlers do not execute JavaScript. If the answer arrives after hydration, it does not exist to them

  • Question and answer markup. The cost, downtime, pain, and candidacy questions patients actually ask, marked up and visible on the page rather than hidden behind a script

  • Corroboration. The same facts stated consistently across your site, your profile, and your listings, because agreement across sources is what an engine treats as confidence

Phase 05Treat

Voice and conversational search

The searches people speak rather than type, which are longer, more specific, and much closer to booking.

  • Speakable markup. The passages that make sense read aloud, marked as such

  • Question-shaped headings. Content structured around how much, does it hurt, how long, and am I a candidate

  • Open now and near me. Hours in structured data so an assistant can answer whether you are open, and neighbourhood language in plain sentences

  • One-tap calling. Every number a tel link, because a voice search that ends in a memorised phone number ends

Phase 06Treat

Local surface and the map pack

The three results above the fold on a phone. For a practice patients have to physically reach, this is the most valuable real estate in search.

  • Profile optimization. Primary and secondary categories, services, attributes, booking link, and the storefront or service-area configuration that matches how you actually operate

  • Site to profile parity. Name, address, phone, and hours verified identical across your site, your schema, and your profile. Drift here is the most common cause of a stalled map pack

  • Citation consistency. The directories that matter for your vertical, corrected and kept consistent

  • Review systems. Compliant velocity with no gating and no incentives, HIPAA-safe response templates that never confirm someone is a patient, and a recovery process for legitimate negatives

  • Geo-grid measurement. Rank across a grid of points around your practice, so you can see which neighbourhoods you are invisible in rather than one flattering number

Phase 07Treat

Content and clinical authority

Treatment and condition content written to answer completely, attributed to a named clinician, and safe to publish.

  • Pillar and cluster architecture. A page per treatment, supported by the condition and question pages that feed it, linked programmatically rather than by hand

  • Named clinical authorship. An author and, where it applies, a medical reviewer. Anonymous health content is the weakest form there is

  • Claim-safe by construction. Claims narrowed to what your evidence supports rather than broad claims propped up by a disclaimer, which is the approach the FTC actually asks for

  • Results imagery done properly. Consistent lighting and angles, advertising-specific written consent per image, and typical-result disclosure rather than results may vary

  • Freshness cycles. Scheduled re-verification, because a page that has not been reviewed in two years is a liability in a medical vertical

Phase 08Treat

Conversion and the path to the calendar

Traffic that does not book is a cost. This phase is about the distance between arriving and being on the schedule.

  • Booking path engineering. Taps from landing to booked, measured and reduced. Every additional step is a share of patients who do not finish

  • Speed to lead. Form and call routing so an enquiry reaches a person fast, because the practice that answers first usually wins the patient

  • Objection handling on the page. Cost, financing, downtime, and what happens on the day, answered before the consult rather than during it

  • Call tracking and attribution. Calls attributed to channel so cost per booked patient is a measured number rather than an estimate

  • Testing. Structured tests on the paths that carry the most patients, with revenue per visitor as the measure rather than bounce rate

Phase 09Measure

The measurement loop

The campaign is not finished at launch. It is finished when the numbers move, and the numbers are yours.

  • Booked appointments by channel. Reported monthly in your numbers. Not impressions, not lead counts, not a dashboard screenshot

  • Geo-grid heatmaps. Map pack position across your catchment, tracked window over window

  • Search Console and rank tracking. Clicks, impressions, and page-level movement, with competitor overlays

  • Profile actions. Calls, direction requests, and booking clicks originating from your Google Business Profile

  • AI visibility radar. Mentions and citations across the assistants your patients now ask first, tracked as they move

  • Scheduled checkpoints. Reviews at 30, 60, and 90 days against the KPIs agreed in phase 01, not against goalposts moved afterwards

Running through every phase

The compliance spine

Not a phase. A constraint on all of them. In this industry compliance decides which marketing is even available to you, and it costs almost nothing when it is designed in rather than retrofitted after a letter arrives.

Everything below traces to a named primary source. We are a marketing agency and we are not your counsel. Your lawyer signs off, we build to what they say.

Advertising rules by state

Health data and tracking

Advertising tags stay off intake, booking, and portal pages. Worth stating precisely: a federal court vacated the part of the OCR tracking bulletin covering IP addresses on unauthenticated pages in June 2024 and HHS withdrew its appeal that August, so that theory is gone. The rest of the bulletin, the private wiretap litigation, and state privacy law are not. Neither Google nor Meta signs a business associate agreement.

Accessibility

WCAG 2.2 AA built into the markup. Digital accessibility filings reached 3,117 federal cases in 2025 by Seyfarth's count, and a practice with a physical location is reachable under Title III in every circuit through the nexus theory. Overlay widgets are not a defence and are increasingly treated as a signal worth investigating.

Advertising claims

The FTC requires competent and reliable scientific evidence behind health claims and judges the net impression, including what before and after imagery implies. It names results may vary specifically as inadequate. We narrow claims to what your evidence supports instead of disclaiming broad ones.

State board rules

Requirements vary and they bind the practice, not the agency. California requires the supervising physician's name or fictitious name permit on every page promoting services. Texas rule 22 TAC 165.1 requires shown results to be representative and advertising-specific patient consent. We build to your state's rules and keep a written record of what we relied on.

Review integrity

No gating, no incentives, no responses that confirm someone is a patient. Platform policy violations and privacy exposure are both real, and a suppressed profile costs more than the reviews were worth.

Twelve gates, and the loop runs until they pass

Nothing goes live until every gate clears against the rendered production page, not against a checklist somebody ticked. The page a patient sees is the page that passed.

01

Build and links

02

Mobile at 375px

03

Structured data validity

04

Content and claim review

05

Images and alt text

06

Core Web Vitals

07

AI readability

08

Internal linking

09

Zero-click surfaces

10

Design consistency

11

Accessibility and legal

12

Live production verification

Roughly how it unfolds

Directional ranges based on how this work behaves, not a guarantee. Real timing depends on your starting authority, how competitive your market is, and how quickly reviews accumulate. Anyone who guarantees you a ranking is describing something they do not control.

Weeks 1 to 4

Diagnostic, protocol, and build start

Weeks 4 to 10

Site live, profile and tracking corrected

Months 3 to 4

Local and AI surfaces begin moving

Months 6 to 12

Content compounds, authority accumulates

How we operate

The rules we do not break

Nothing fabricated, ever

No invented reviews, ratings, statistics, or results. If real data is unavailable, the element does not ship. This site holds itself to it too.

Compliance beats every optimization

HIPAA, FTC substantiation, state board advertising rules, and platform policy win over any ranking tactic, every time, without a discussion.

The live site is the only truth

A fix is done when we can see it on your production domain, not when a report says it shipped and not when it looks right in a mockup.

Demand-gated scale, never doorways

Pages exist where there is verified demand and something unique to say. Google names doorway fan-out as spam and it is not worth the risk to your domain.

You own everything

Site, domain, ad accounts, analytics, reviews, and data. Fire us and keep all of it. Month to month, re-earned every 30 days.

Measure outcomes, not artifacts

Schema counts and page counts are diagnostics. Booked appointments, map pack position, and AI citations are the scoreboard.

Run for these practices

Prefer the methodology rather than the deliverables? The growth protocol covers how we work and what each service engine does.

Questions

What is the difference between this and a retainer with a normal agency?

Sequence and ownership. Most retainers sell a bundle of activities billed monthly, so the work that shows up in a report gets prioritised over the work that changes patient volume. The campaign runs in a fixed order because the order is load-bearing: content cannot rank on a site crawlers cannot read, and a map pack cannot move while your name, address, and phone disagree across three systems. You also own every asset from day one, and the engagement is month to month, so we have to keep earning it.

Do I have to take the whole campaign?

No. The diagnostic comes first for everybody, and it frequently shows that one or two phases carry almost all of the available gain for a given practice. A practice with a fast, well-built site and a neglected Google Business Profile does not need a rebuild. We tell you that rather than selling you the full sequence.

How long before we see something?

The build and the profile corrections are visible within weeks because they are things we ship rather than things we wait for. Local and AI surfaces typically start moving in the second or third month, and content authority compounds over six to twelve. Those are directional ranges from how this work behaves, not a guarantee, and anyone who guarantees you a ranking is telling you something they cannot control.

Why does a marketing agency lead with compliance?

Because in this industry compliance decides which marketing is available to you. An advertising pixel on an appointment page is a privacy claim waiting to happen. An unqualified guarantee is a state board matter. An inaccessible booking form is a demand letter. We would rather build inside the rules than build something you have to unwind, and the constraint costs almost nothing when it is designed in from the start rather than retrofitted.

Who actually does the work?

The people you meet. We work only with health and wellness practices, which is the reason we already know what a Boulevard integration or a state board disclosure requirement involves rather than learning it on your budget. If a specialist is brought in for something, you are told who and why.

What do you need from us?

Approvals, access, and the clinical review. Access to your domain, analytics, Google Business Profile, and practice management system. Approvals on direction and copy. A clinician to review anything clinical before it publishes, which is not optional and is the part we cannot do for you.

Phase 00 is free

Every campaign starts with the diagnostic, and you can run the technical half of it yourself right now. It takes about ten seconds and the chart is yours whether we ever speak or not.

Or talk to a person