Case study · 90-day engagement
A Cincinnati chiropractor had been running paid ads for two years with the same agency. The agency was bidding on bottom-funnel chiropractic terms in a city where the keyword auction is dominated by 24-Hour Chiro and the bigger franchises. CPL had been climbing every month and the close rate had been declining as price-shoppers compared the practice against $19-first-visit franchises.
The challenge
Chiropractic in Cincinnati has been polluted by aggressive franchise marketing offering "$19 first visit" bait, which usually upsells to a $1,200 treatment plan after the first session. Honest practitioners cannot match the headline. The owner had been losing the keyword auction for two years and was about to cap his ad spend and just rely on referrals.
Audit findings:
The plan
Designed a 3-tier membership: $99/mo for one adjustment + one therapy session, $149/mo for two adjustments + two therapy sessions + family discount, $199/mo for unlimited adjustments + monthly massage + family discount. Cancel anytime, rollover unused visits. The math is built so members average 6-8 visits/year at a price below per-visit cash pay.
New page that leads with membership pricing transparency, the wellness rationale (most chronic back pain needs ongoing care, not a 12-pack), and a "see what your monthly cost would be" calculator. The first-visit special is moved into a secondary CTA below.
Stopped bidding on "chiropractor near me" against the franchises. Started bidding on "monthly chiropractor cincinnati," "chiropractic membership," "back pain membership program," "wellness plan chiropractic." CPL dropped from $87 to $31 because the keyword auction is way less competitive.
Two-message SMS sequence to the 2,800 past-patient list: "We launched a monthly maintenance plan, $99/mo, cancel anytime. Reply MEMBER if you want details." About 11% replied. About 38% of those signed up.
In-office, every first-visit patient now gets a 4-minute walkthrough of the membership program and a 30-day trial offer. About 47% of first-visit patients sign up for membership in the office.
AI tools we used
We do not pretend the work happens by hand. Three of our internal tools are the reason this engagement moved as fast as it did. Each of them replaces what used to be days of human time.
Side-by-side calculator showing per-visit vs membership cost for typical care patterns. Drops the "is this worth it" objection in about 90 seconds.
Segmented SMS to your existing patient database with a membership-specific offer. Recovered 11% reply rate, 38% of replies converted.
4-minute structured walkthrough we trained the owner to deliver after the first adjustment. Lifts first-visit-to-member conversion from 11% to 47%.
The execution
| Week | What we shipped | What moved |
|---|---|---|
| Week 1-2 | Membership tier design + transparent pricing page | First member signup on day 9 |
| Week 2 | Landing page lead-with-membership live | Bounce rate drops from 64% to 38% |
| Week 3 | Google Ads keyword pivot to membership-intent | CPL drops $87 → $44 in week one of pivot |
| Week 4 | Past-patient SMS reactivation campaign first wave | 124 member signups from old patients |
| Week 5 | In-office membership walkthrough trained and deployed | First-visit-to-member conversion 11% → 47% |
| Week 8 | Mid-engagement review | Membership signups stable at 89/mo |
| Week 12 | Quarterly review | CPL at $31, 89 monthly signups, retention at 11 months |
The numbers
The CPL drop and signup volume came from:
The practice stopped trying to win the first-visit price war and started selling something the franchises do not sell: actual ongoing care at predictable pricing. Different product, completely different economics.
I told my last agency I could not match the $19 ads. They told me to lower my prices. I told them they were missing the point. ActionScale did not just listen. They built me a different product to sell.
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