Local SEO advice is written as though every local business is the same business. Get into the map pack. Get the top three. That’s the game.
For a roofer, that is close to the whole truth. Someone with water coming through a ceiling calls the top three results and hires whoever answers. The website barely gets read.
A chiropractic practice is not that business, and the difference changes what you should spend money on.
Nobody wakes up with back pain and books a course of care that afternoon. They put it off, they mention it to someone, they look at three practices, and they read. The map pack gets you into the set of three. What happens next happens on your website.
Three clinics, three audits, the same five gaps
I audited three healthcare practices this year — two chiropractic and one med spa, in three different towns, three different web builds, no connection to each other.
Five things were missing from all three:
- The Google Business Profile map was missing, or embedded on the wrong pages, or pointing at a different business entirely
- No schema markup — on one, none anywhere on the site
- No reviews page on their own website
- No video, anywhere, and no YouTube channel
- No decision about location — service pages with no place name, contact pages listing four towns
Three sites is a small sample and I won’t pretend otherwise. But these were not five subtle judgement calls. They were five things a practice is either doing or not doing, and none of the three was doing any of them. Fifteen out of fifteen. After fifteen years I can tell you that isn’t coincidence — it’s what the standard local build leaves out.
I’ve written up all five in detail, with what each one is actually for and the two claims about them that get oversold: three clinics, three audits, the same five gaps.
The number that isn’t an SEO problem
Those three practices had 44, 93 and 8 reviews.
Same profession, same year, same kind of town. The clinic sitting on 8 had a perfectly good practice and no process for asking.
I’m not going to dress that up as something I can fix. It’s the single biggest local visibility difference between those three businesses and no amount of work on the website closes it. If your count is closer to 8 than 44, building a process for asking will do more for you this year than hiring me will — and I’d rather say that now than take a retainer and explain it in month six.
What I can do is make sure the reviews you have are working. On all three sites they were sitting on Google’s property and nowhere else. A reviews page on your own site — real quotes, attributed, the treatment named, a link out to the profile so anyone can verify it — is a page you own, that can rank, and that answers the question every prospective patient is actually asking while they compare you against two other clinics on a laptop.
Why the maths is easier here than almost anywhere
This is the part I like about working with practices, and it’s worth being open about because it cuts both ways.
A chiropractic patient is not one transaction. It’s a course of care, and often years of intermittent maintenance after that. So the lifetime value of one new patient is high enough that the honest question isn’t “will this multiply my traffic.” It’s “can we reliably add one or two new patients a month.” For most practices, one covers the cost of the work.
That’s a low bar and I’d rather state it plainly than imply something grander. It also means you can check my work without a dashboard: you know whether new patients are arriving.
The flip side is that it makes over-promising very easy in this vertical, and you should be suspicious of anyone who leans on it.
The location question, which nobody answers
All three sites were ambiguous about where they operate. Not wrong — ambiguous. Service pages with no place name anywhere. A contact page listing four towns while nothing else on the site named one.
There are two legitimate answers and the sites had chosen neither.
If you want one location, commit to it. The service pages carry the town in the URL, the title, the H1 and some of the H2s. Everything points at one place and Google gets a clear signal.
If you want several, you need a real page for each — different content, different staff, directions, parking, local specifics. Not a template with the town swapped out. That build fails as a set: forty near-identical pages don’t rank individually and they drag the site down collectively. Google names it as doorway abuse.
The test is simple. If the page would still be useful with the place name deleted, build it. If it wouldn’t, you’ve written a doorway.
Pick one. The wrong answer executed properly beats no answer.
What nobody can tell you
When a practice fixes the map embed, adds schema, builds a reviews page, publishes three videos and finally decides which town it’s in — and the phone starts ringing — nobody can isolate which piece did it. Not me, and not the agency showing you a graph.
What you can reasonably ask is whether the work was worth doing on its own terms. All five of those gaps are worth closing whether or not you can attribute the result, which is a more honest way to buy this than a promise about rankings.
The three things I’d check on your site first
Open your contact page and your Google Business Profile side by side. Do the name, address and phone number match exactly, character for character? On one of the three, the map on the contact page was showing a different business entirely.
Search your own practice name and look at what comes back. If the profile and the site disagree about who and where you are, you’ve handed Google an ambiguity to resolve, and it may not resolve it your way.
Count the pages that mention your town. If it’s only the contact page, your website has never been told where the practice is.
When not to hire me
If you’re already at capacity. This is a real one. Two campaigns I ran ended because the client got more calls than they could handle, and that’s a planning failure on my side as much as theirs. Before we start I’ll ask how many appointment slots you actually have and who’s answering the phone at seven in the evening.
If you have almost no reviews and no way to ask for them. Fix that first. It’s free and it outperforms anything I’d do to the website.
If you need patients this month. This work takes about six weeks to start showing and months to prove. For a deadline, use ads.
If your site is fine and something else is the problem. It happens. If I look and there’s nothing worth fixing, I’ll tell you that, and I’d rather do it on a call than in month six.
If a site should be ranking and it isn’t, that’s the work I do. Local SEO covers the profile and map pack side. If you’re not sure which of several plausible problems is costing you, that’s what an SEO audit is for.