The verdict
One of the three practices I audited this year had eight reviews. Another had ninety-three. Same profession, same year, same kind of town. If your count is closer to eight than forty-four, building a process for asking will do more for you this year than hiring anyone to work on your website. I would rather say that before the retainer than explain it in month six.
Eight reviews. Ninety-three reviews. Forty-four reviews. Three healthcare practices, same profession in two of the three cases, same year, same kind of town, and no connection to each other.
The clinic sitting on eight had a perfectly good practice. Patients liked it. It had simply never built a habit of asking.
Why I will not dress this up
It is the single biggest local visibility difference between those three businesses, and no amount of work on the website closes it. Not better service pages. Not schema. Not a faster theme. Not me.
Google’s own list of things that improve local ranking includes getting more reviews and responding to them, alongside verifying the business and keeping the information complete. The same page says plainly that there is no way to request or pay for a better local ranking. There is no route around this one. You either collect them or you do not.
The bar moved, which makes it worse
BrightLocal’s February 2026 survey of 1,002 US adults found 31% will only use a business rated 4.5 or above, nearly double the 17% who said so previously, and 74% want to see reviews from the last three months.
Read the second half of that carefully, because it is the part clinics miss. Recency is a separate problem from volume. A practice with sixty reviews where the newest is from 2023 fails a test that a practice with twenty-five fresh ones passes. Sitting on a good historical number is not the same as being current.
What a process actually looks like
Not a campaign. A habit, attached to a moment that already happens.
What works in a clinic
- Pick the moment. The end of a course of care, or the visit where someone says they feel better. Not the first appointment, and not a mailshot three months later.
- One person owns it. If it is everybody’s job at the front desk it is nobody’s, and it stops in the first busy week.
- Ask out loud, send the link after. The request happens in the room. The link is just the mechanics.
- Never filter who you ask. Asking only the patients you expect to be positive is review gating, it is against platform policy, and the risk is not worth the half star.
- Count it monthly. Four a month is transformative over a year and invisible over a week, which is exactly why it gets abandoned.
What I can do while you do that
Make the reviews you already have work harder. On all three of those sites they were sitting on Google’s property and nowhere else, which is what a reviews page you own rather than a review widget is for. Twenty-five reviews republished on a page that ranks, in the patient’s own words, beats ninety-three that only exist on a profile.
That is a real piece of work and it is worth doing at any review count. It is just not a substitute for the asking.
The uncomfortable version
If you are choosing this year between paying someone to work on your site and putting a process in place to ask every satisfied patient for a review, and your count is in single figures, choose the second one. Come back to me next year with sixty reviews and there will be considerably more worth doing.
I am aware of how that sounds coming from someone who sells the first thing. It is still true, and the alternative is taking a retainer to work around a problem I cannot reach from the outside.
The short version
- Eight against ninety-three, same profession, same year. The gap is not a website problem.
- Google names more reviews as a local ranking factor and says outright you cannot pay for local ranking.
- 31% now filter at 4.5 stars, up from 17%, and 74% want reviews from the last three months.
- Recency is its own problem. Sixty old reviews can lose to twenty-five fresh ones.
- Build a habit, not a campaign. One owner, one moment, counted monthly.
- Never ask selectively. Gating is against policy and not worth half a star.
- If your count is single figures, do this before you hire anyone. Including me.
If a site should be ranking and it isn’t, that’s the work I do. SEO for chiropractors is where I set out what actually moves the needle for a practice, and an SEO audit will tell you whether reviews are your constraint or a distraction from the real one.
