Fix The Follow-Up, Save The ROI

Tired of blaming “bad leads” while your calendar stays light? We pull back the curtain on what really kills ROI for chiropractic clinics: slow response times, call-only thinking, and booking processes that create friction at every step. If a lead completes your form, they are not cold—they’re curious and perishable. The difference between eight bookings and fifteen from the same 30 to 50 leads is speed, clarity, and consistency.

We walk through a first-120-seconds playbook that fires friendly texts immediately, confirms the offer, and gives a two-click path to a live calendar on mobile. You’ll hear how a clinic generated 102 leads and booked zero visits—and why that points to broken systems, not broken ads. We break down multi-channel follow-up that actually matches modern behavior: SMS for speed, email for context, and timely calls for high-intent prospects. Most conversions happen after five to ten touches, so we share a cadence that scales without burning out your front desk.

From removing six-page intake forms to building short-term and long-term nurture, every tactic centers on trust and ease. We cover practical ways to track reply rates by touch, prioritize warm leads, and reactivate old Meta and website leads that still hold hidden value. The takeaway is simple: ads create attention; systems create patients. Tighten the back-end, reduce friction, and watch booking rates climb without adding a dollar to ad spend.

If this breakdown helps, subscribe, leave a quick review, and share it with a colleague who keeps saying “the leads are bad.” What will you fix first—speed to lead, booking friction, or multi-touch follow-up?

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3. Book a free discovery call with Enrico to level up your business

Chapters

• 0:40 Leads Aren’t The Problem
• 1:32 The Leaky Bucket Of ROI
• 3:12 Referral Era vs Today’s Reality
• 5:38 When 102 Leads Book Zero Visits
• 8:48 Speed To Lead And Trust
• 12:24 Kill The Call-Only Mindset
• 15:59 Remove Friction From Booking
• 20:39 The First 120 Seconds Playbook
• 24:39 Short And Long-Term Nurture

Transcript

SPEAKER_00: 0:20

If you're blaming meta ads for your ROI, this episode might sting a little bit. Most chiropractic offices don't have a lead problem, they have a follow-up problem. Today we're going to break down exactly where the money is being lost and how to fix it fast. Welcome back to another episode of Marketing 101 for chiropractors. This episode is for clinics that are running Meta or Google Ads, offices getting leads but not enough bookings, and docs that are just frustrated with the low quality leads. A lead that doesn't book is rarely a bad lead. It's usually a follow-up problem. I think I've done an episode like this over the last three years, probably three or four times. We know this. How do we improve the leaky bucket? Those little leaks in the business bucket that, if we repaired, would make a dramatic effect in the overall results. And ROI is encompassing a whole bunch of things. But when it comes to follow-up, I think this is where we get the most frustrated as business owners is how do we, you know, we're generating leads. It's a different type of marketing that we're not used to in chiropractic. The most useful type of marketing that we know of in chiropractic is referral marketing. We're just trained on it. It's our innate intelligence in our profession is that we help some people, some of them refer, and we grow our practice. And that's how it's been for the last hundred years. Let's be honest with it. People told other people about what to do and what chiropractor to go to. I mean, that has always been the staple. Times have changed. Times have really, really changed. Human-to-human loyalty is no longer a value that our society cherishes anymore. Loyalty doesn't get anyone anywhere anymore. And it I can see it fading. It's been fading in the younger generations. There's loyalty gets you nowhere. When really the older generations, I think my grandparents and my parents that um used to talk, you know, tell me about growing up, loyalty got you everywhere. If you stayed with the company, you moved up the ranks, you got in you know, bonuses, you got salary bumps, you got uh paid time off, you got you got things by being loyal, and that you don't get things anymore. And it's not just that, it's just people just don't want to be loyal anymore. There's it, there's really nothing out there for it. So, same with your patients, they're not out there to refer like they used to. It's different. Now it's like I'll just go on social media and find the next shiny therapy and I'll go do that instead of chiropractic or go try the other chiropractor because they're doing a$29 special. Uh, it's just the reality of it. So, follow-up is where we need to tighten our reins as business owners and really dial into to see them. What I commonly see is that you know, we're getting 30, 40, 50 new leads a month, and only eight, 10, 15 new patients come out of it. The front desk says they didn't answer. I reached out to them, I text them, I email, they called, they didn't answer. And the and the doctors assume that the ads are failing. They're like, we we tried calling and no one's coming in. I had one office, uh, this was probably three months ago. So fairly recent. 102 leads in 60 days, and less than 60 days. It was less than two months because they ended up, they're like, Oh, we gotta quit. No, no new bookings out of the 102, none came in. I was like, okay. That's weird. That's the weirdest that the guy even told me after the first month, he's like, We've had 50 leads. This is the most leads generated per week that he's had on any of his. Not that my ads were any better, but and he's like, We got nothing, man. They're like Spanish, they don't respond. They, you know, all the excuses. I'm like, interesting. Maybe, maybe it's a learning curve. Maybe let's try it and let's keep going. I mean, get your team. The team said they were following up. Um, and then I go into their you know, high-level account. You can see how many texts are being sent, how many emails, aside from the automations we're sending out, one email. No, no emails. They didn't email, no email, a text. A text. Uh, this is Sarah from yada yada yada. Are you would you like to book in? And uh, and I was like, and I talked to the dog, I was like, listen, if if you're playing baseball and we're just playing for fun, I'm the pitcher and I throw you a hundred pitches. Yeah, I'm not gonna throw you a hundred strikes. Let's say, you know, 30 of them were ball, you know, and you didn't want to swing, they were just bad pitches, they're bots, they're not good leads. I get it. What about the other 60 or 70 pitches? If you don't hit one ball, am I the bad pitcher or you just suck? And that's how that conversation ended. You suck, buddy. Um, and your team sucks, and their parents suck, and their whole family suck. You all suck. Uh, that's the truth of the when we look at the numbers, right? How can you get a hundred pitches thrown at you and not one person come in through the front door? That's a you problem, not an ads problem. So, this is what it can be that bad. I know some of you are listening, you're like, What? How do you get a hundred leads off of Metaform and no one responds? It's crazy. So the ROI leak that nobody's tracking is is, you know, if booking rates go from 30%, let's say, to 50%, let's say booking rates, you know, you got those 30 leads, 30% of them book, eight to 10. And you just nudge it because you trade you change some systems in your office and you can get that to 40% or 50%. This will skyrocket without increasing any ad spend. It is the most logical way to work on, and literally no offices do anything to improve this. And after helping chiropractors do this stuff for over five, well, year seven now, um, I had the do-it-yourself programs, I had the learning programs, I had the Kajabi courses, I had all this stuff. And the implementation rate was next to zero. The watch rate and the completion rate was about 18%. I realized chiropractors don't want to learn this stuff. They don't want to do this stuff. It's like CE credits. We don't want to go and do all the risk management. No one wants to do it. I don't want to do the HIV course for one credit. I don't want, I don't want to, I don't want to. Um, but we got to, and we do it because we got to keep our accreditation and you know, our licenses. We got that. And then there's the the you know, the 13 hours of credit that you actually do want to go do. You're like, I'm gonna go do some more pediatric work, or I want to go, you know, something you actually enjoy. And even you can just show up to the course and you're like, I don't want to do this, you still don't want to do it because you've been practicing for 20 years. You don't want to do. I get it. I hear you, I feel you. Um, but this stuff in your office, the stuff that you don't want to do is what you need to do. The stuff that you want to do is probably what you don't need to do. Let's be honest. If you enjoy the stuff that you enjoy, adjusting patients and helping them and treatments and the special, you know, thing that technique that you do, you're like, I enjoy doing this. Of course, you need to do this. You need you need to do this, but you won't be able to do this if you don't have any more new patients, right? Or any more new people coming into your office. So most clinics try and scale traffic when they haven't fixed conversions, and that's where the whole train falls apart. That's a different episode for a different day. This is why chiropractic uh offices lose leads. A slow speed to lead. First contact happens, and then hours later, something else happens. Leads go cold fast. People are like, Facebook leads are cold leads. No, they're not. They're slightly, slightly warm leads because they filled out a form and gave you their information. That's not a cold lead. A cold lead is you pick up the phone and you start dialing random numbers with the area code where your office is at, and you just start calling. That's a cold, that's a cold lead. Or if you get a buy a list of emails and you email it, that's a cold list. Or if you buy a list of phone numbers and you start calling, you hire a call center to make calls in your local area to introduce you. There was Metro Marketing. I remember those guys out of New Jersey. They that's what they did. They just started calling numbers, uh, and then had a script for your office. It was a thing. And those are cold leads. Those are like people like, why are you calling me? Are they hanging up all the time? That's cold leads. So if somebody gave you their information, that's not necessarily a cold lead. They saw your ad, they gave you the information. Kind of lukewarm. It's your job to keep them warm because if they go cold, they're dead. So the first five minutes matter more than the next five hours. And this is why you implement automations. The automations can get all the way to a booking done if you want. So we have this call-only mentality in a chiropractic office. Please acknowledge that. Please acknowledge it. I find the younger uh front desk staff um are cooler with text. So that's that's a good thing, I guess. But there's this call-only mentality where many offices rely on phone calls, and modern patients prefer text. Uh, so people fill forms when they can't talk on the phone phone. They're putting their kids to bed, it's quiet. I feel like I can barely talk on the phone most of the time now, and it's like a culture, it's like a shift in culture for me. It's like I used to pick up the phone and call people all the time, and now I feel like I barely want to get on a call. My wife calls sometimes and I decline the call and I text her. I hope she's not listening. But that habit where I just don't want to. I'm at the office, I'm doing I'm in the car, I'm I don't know, waiting for to pick up the kit. I don't know. I just don't want to talk. Just send me a text. Um, because it's probably not that important. Just send me okay, anyways, it's my marital life, but whatever. Um, call the call-only mentality and how that kind of seeps into it, and then just the overwhelming booking processes you guys all have. Long six-page intake forms, confusing instructions, uh, too many steps. Why are you giving this to a Facebook lead? You nuts. You have a one-page intake form fillable PDF that goes to their email and they can fill out. When they pop this thing up, half of it's autofilled because it's their name, phone number, address, everything the demographic is filled out. All they have to do is chief complain when this started, when was the onset? Where's the pain? Does it travel? Does it radiate? Have you seen any other doctors with this? Is there anything else you want us to know about? One page. That is your I wonder if that's a major problem for many of you. Uh, there's just too many steps. Like, can you book an appointment? The automation should be I click this, I put in my info, Enrico, uh, my phone number, email, boom,$49 chiropractic special at ABC Chiropractic. I'm like, yeah, I want that. Boom, on my on my Instagram. Immediately on my phone. Bing, I look at it. Congratulations on signing up for your$49 at ABC Chiropractic. Confirmation. This thing worked within seconds. I get this. I also get an email that I'm not going to look at because I'm not checking my email right now, but an email went in there too. Longer description because email I can write a whole paragraph. Longer description. Thanks for signing up for your$49. This includes your exam, consult, x-rays, just like said, with a picture of the ad that you had on Facebook in the email with a picture that goes with that email on there, or a picture of you, or a picture of your office. So it confirms, oh, this is legit. Then within 120 seconds, there you're getting another text. Hey Jenny, or hey Enrico, it's me. I'm the leader, I guess. Hey Enrico, um, can I help you book your appointment? Then, or hey Enrico, the next step is booking your appointment. Can I help you get that appointment booked right now? You're trying to engage them. You get an engagement, you've turned the lukewarm lead into a warm lead. And then that engagement triggers them in your opportunities into the next calm as a warm lead or responsive. And now when your team shows up the next day, because this is all happening at 9 14 p.m. on a Tuesday night, when they show up on Wednesday morning, they've got the the warm lead there. They're calling them 8 05, 8 15, 8 35 a.m., whatever time you guys open up. Those calls are happening immediately. That's priority in your office. So you call them and you leave a voicemail or you connect with them. There's just there's just that process there. And that was just the first 120 seconds. That's within the first two minutes of what they do. If there's no engagement, within 30 minutes, they're getting another text and another email. Another one within 30 minutes. I don't want an hour to go by without multiple contacts. Then within the 30 minutes, they've got this. Hey, if it's easier for you, save this text for later and book an if it's easier for you, you can book right now with two clicks. Boom, and your booking link. You click, they click this, they book the new patient appointment. Goes straight to your go high level calendar, it goes straight to your uh review wave calendar, it goes straight to your perfect patients calendar, or not perfect patients, track stat calendar, your SCED calendar, I don't care what you use, JN app, whatever it is, it goes straight to there. They see the openings as a new patient and they book it in. Some offices kick that. Now, when you have that, you have a funnel. That's a true funnel. Then the call is ruthless. The calling is your team is ruthless on the warm leads, the engaged leads, just ruthless on them. It gets to the point where the fifth or sixth voicemail is like, hey Enrico, calling you again. It's Jen from ABC Chiropractic. I am going to stop bothering you. Uh, if we thought you were interested in this$49 promo, I don't think you are because you're not responding. If you do want to take advantage of it, you can just call us at this office and just remind me of the$49. I'll take you off my list. I will stop bothering you. That's our last voicemail. Uh, no run, you know, we have a no-run nurture sequence. So one call attempt, and then the lead mark is dead or lost or non-responsive. No automated follow-up. So that's our system with the automation within the first few minutes. Then the call system that we have in the office, then they're put into a short-term and a long-term nurture sequence in the automations. So after three days goes by, they get kicked into a short-term email and text campaign. Book here. Book here. Book here. We also do this. You can book this here. Did you know we do this? If you want this, book this, click here. They just get all these follow-ups. Uh, sometimes they'll DN DNS and say, do not disturb anymore, cancel, stop. That's fine. Great. Now we know we don't want to text you anymore, but we sure as hell can call you, and we will. Um, and that's and that's that. Then they're put into a long-term email nurture sequence. I think ours is 20-something emails, and it's every seven days, then every 14 days, then every 14 to 21 days. So they get it tapers down to one to two emails a month. Uh, no more booking links. All about everything that we do, Google reviews, cases we've helped, symptoms we've helped, because we really don't know what their specific symptom was because they never came in. I guess you could tailor it if you ask the questions on all your forms. So the biggest follow-up mistakes is that waiting for the staff to remember. And many of you have this type of a system in your office. It's if you if you're front desk, that one person, I know you guys all have that one person that does all the calls, they know they're looking at the go-high level all the time, they know the names. Uh, they're just doing manual follow-up on their own time, in between doing all the other hundred things that they do for your office. And that's the person who you're leaning on. There's generic text messages. Hey, this is full life chiropractic. Just reaching out again. Those are generic. Uh uh, no multi-channel approach. We're not using all the SMS, email, calling, retargeting. We're not doing, you know, we're doing maybe one of those things, two of those things. And then after honestly, two days, people stop after 48 hours. Many patients book after five to ten touches. Ooh, hang on a second. Rewind. Many patients book after five to ten touches. You have been analyzing your ads on the people that have been booking with one, two, or three touches. Remember that second text we send out? Hey, if it's easier for you, you can book this link. You're counting it on that. You're like, that second text that we send, only like one out of 40 leads books an appointment. I'm like, yeah, because that was their second touch. They're not even they don't know you. They still don't even know if these texts are real. If they click that link, what is it? Timu.com, where where's it going to? They don't know. So there's no trust. High performing clinics do something very different. Very different. The message goes without with out within seconds. It's automated, it's friendly, it's conversational, it's easy booking links. They have a simple scheduling process. They click the link, a calendar pops up with the availability times. That's it. It's a Google calendar, it's a high-level calendar. It's just simple, it's there, it's generic. They remove friction, all the and then the patient doesn't have to enter in all their information again. They click on it, first name, last name, phone number. Boom. Now it's another notification into your system saying that you booked, you have a booked schedule appointment. Clear time slots, it's mobile friendly. It pops up on their mobile app. It doesn't look like crap, it's just easy on their form. Then we have the nurture flow for 30 days, educational text, short videos. It's all in your email sequence. You're building trust, you're not chasing it, you're just building it over time. If they open 10% of these emails that go out and you sent out 26, so they open two to three of these emails, they've learned something. They're like, oh, these guys look good. They're legit, you've built your credibility. That, you know, you may never hear from that lead again. Except two years down the road, they call you up and like, hey, I'm looking to become a new patient. They don't remember the promo, they don't remember anything, but you became an authority in their life because you're in their email inbox. And then we have what most people don't do is a lead reactivation. Old meta leads. What have what did you do with all those meta leads? I've been running ads for seven years. What did we do with those leads from five years ago that never came in? They're in sequences. We even have a recall system on that where we call them. Old decompression leads, old website forms. There's huge opportunity to call all those people. So this is what I've seen that works. Clinics double bookings without increasing ad spend by doing the simple things on the back end with the conversions. They follow up the follow-up speed has changed in their office, their observations, you know, from the lead perspective has changed. That's where the shift happens for your ROI. Is when you look at this as the consumer, as the consumer, you're looking at this as the business owner and new patients through the door. Of course, that's what triggers the marketing effect for you to run ads and do marketing. I think everyone understands that. Then you start running marketing. Now, whether it's good or bad marketing, that's you have to analyze the data to see what's going on and what you're doing. But then it's the consumer interaction, the consumer experience where we for some reason drop off. I I just don't know what gone on. I mean, I spent, I'm in my building now for three years. We I think I have one of the most beautiful offices I've seen in chiropractic. Did it on purpose? Did it really move the needle from did it really make us more money or any? I I don't know. I don't know. But being a hole in the wall doesn't help you in the long run, right? It doesn't help. Do people care? Not really, but yes, subconsciously they do. Consciously, they don't. They just want good healthcare. Um, but these little things, you know, we're focusing on the wrong things. If we focus on the right things with ROI, I think you'll see a massive shift. So rapid action that I want you to focus on right now is go and audit your instant text response. What are they saying? What are they doing? What's the conversion rate on the first text that goes out? How do you know the conversion rate? You look, you go in there and you see how many people have responded after the first text. The person who's doing your calls will know. Your front desk, they'll know. Ask them. Say, hey, how many people after the first text goes out respond? They'll be like, nobody. And then how many people after the second text? They'll be like, oh, sometimes we get a she doesn't, they may not know the number, but they'll be like, sometimes we get a response on that. So we want to reduce the booking friction. What's going on? How many steps do they have to follow to book an appointment? Like, shit, check it. I'm still frustrated with my office's process on this. SCED is moronic, they're idiots. Uh track stat, I don't understand where their concept of practice management is. Review wave kind of on the right track. Um, I I know HIPAA is a hurdle for us, you know, to just get people's info easily. Uh I don't understand how it's 2026 and none of these bozos can run a simple two click system to book an appointment. I I just I don't get it. I I'm so I don't know. I'm gonna I'm gonna go back to travel card uh office and get rid of all my computers. I I don't get it how we're here in 2026. And I don't have a patient's con. I mean, if they're scrolling through social media on their phone, that damn camera on their phone should be able to scan their face and send me their picture into my EHR like immediately. And I should know everything about their address, everything. I know that sounds crazy. That's insane. But I'm like, no, it's 2026, man. Come on. Like, I know that camera's looking, I know the microphone's working, and you can't book an appointment in my office. What is going on? We really that's how you should look at this in your practice. Like, why is there so much friction? That friction creates heat and it's burning money. It's burning your money in your bank account as you sit here and listen to this podcast. It's burning. All that friction that you have in your office is an inferno burning your cash right now as you listen to me. It's nuts. Doesn't that infuriate you? Like, go fix it. Follow up at least for two weeks. Like, I mean, I would make this a system in your office. You got to tell the person that the follow-up is there. And if you have that one person who does everything in your office and now you lean on them for this too, it's a lot. It's a lot. Trust me, I've been through a lot in practice. It puts a lot on that person when they're doing it all. They're responsible for the lead management, they're responsible for the internal affairs. They're responsible. This is probably a second higher. This is probably someone else, even a virtual assistant, uh, or a virtual a virtual CA or um just a virtual call center that is actually good that can do this for you. That's who you want. Stop judging leads after just one call attempt. Your team's not really judging them. They're just like, I don't have time for four calls. I can only make the one or the two, and they're doing it, and there's not getting a response. And we're counting on those one or two calls from RCA at the front to book the appointment, and we're using those metrics saying these leads are bad because we've only converted eight out of 35 lead uh leads to this. But I look at that number, I'm like, eight eight people responded on the first or second call that you made, and they're like, Yeah. And we got them booked. I'm like, that's amazing. That's amazing that you you're a stranger off Instagram, and after two texts, two emails, and two calls, they picked up the second call or they responded or they called you back with the voicemail and they said, Yeah, let's book an appointment. Like, that tells me you had fast follow-up. And the docs are all like, Yes, we did. We called them the same day and then booked the appointment the next day. I'm like, no. So the these rules apply to the ROI on marketing, is is we have to be fast to do this. Use tech to help you, use automations to help you, fine-tune all those things, get the internal processes correct, and you'll avoid the burnout that it takes to build a practice. And then just make sure we track everything. Most if you use high-level, you're getting most of the stats that you need. Ads bring attention to your office. You need them. Systems create the patients. Your ads did not create the patients. Your ads never created the patients. Your ads created eyes on your business. And people are like, oh, that's a chiropractor. Oh, I've got pain. They say they can fix it. That's all it did. Then something had to happen. Your systems had to do something. That automated text to the booking link, that system is how they click the link and they booked the appointment. That call that you guys make within 24 hours to call them, booked the appointment. That follow-up call, that third follow-up call that you do within 48 hours, that was the one that booked them. It's the systems that you create that got the new patients into your office that created a new patient. Otherwise, it's just marketing. It's just eyes on your business. Eyes on your business make no money. Eyes on your business make no money. Next week, we'll talk about why most chiropractic offices offers attract the wrong patients. And I think that duo of this week and next week will bridge the major concerns I've seen over the last 12 months together for most of you. That if you make a switch, you'll notice some massive changes in your ROI without changing a dime in your spend. Get them to have a great week and take care.