Pick a dental marketing agency by what you keep if you leave and by what its report counts. You should own every account it works in, and its monthly number should be new patients from your own practice software. Ten questions test both before you sign, and they work the same for an agency, a dental marketing company or a consultant.
Quick answer
Before you sign, get four things in writing: admin access to your Google Ads account under a practice login, primary ownership of your Google Business Profile, the domain in the practice's name, and tracking phone numbers (the extra numbers that tie calls to ads) you can take with you. Add month-to-month terms or a written exit, and a monthly report of new patients who came in, by source, from your practice software. If call recordings or forms will put patient details in the agency's systems, ask for a business associate agreement, the HIPAA contract for vendors that handle patient information. Today, check your role: in Google Ads under Admin, then Access and security (Google, checked 2026-10-04); in your Business Profile under More, then Business Profile settings, then People and access (Google, checked 2026-10-04).
Who owns the ad account and the Business Profile?
1. Is the Google Ads account mine, with admin access? An agency that runs your pay-per-click (PPC) ads can work from its manager account, one Google Ads login for many accounts (Google, checked 2026-10-04). The account it manages should be yours, with you as an admin. Google lets an admin change who has access and unlink manager accounts (Google, checked 2026-10-04), and an unlinked account keeps its campaign history (Google, checked 2026-10-04). One catch, from that page: if the agency pays Google for your ads on monthly invoicing, unlinking stops the ads unless billing moves first.
2. Am I the primary owner of my Business Profile? Your Business Profile, the free listing on Google Search and Maps, has one primary owner. Managers can do almost everything owners can, except add or remove users and delete the profile (Google, checked 2026-10-04), and only the primary owner can hand that role on (Google, checked 2026-10-04). The agency needs manager access; the primary owner should be a practice login, not the agency's or one employee's email.
Who owns the website, the domain and the phone numbers?
3. Is the domain in the practice's name, and can I take the site? Your domain is registered through a registrar, the company you pay for the name, and the registrant is the holder on record. ICANN says a change of registrant goes through the current registrar, which confirms with the registered holder, typically by email (ICANN, checked 2026-10-04). If that holder is the agency, the agency has to say yes. For the site, ask whether it runs on the agency's own platform and what you take with you: files, text and photos, or nothing.
4. Whose account holds the tracking numbers? Tracking numbers are extra phone numbers that ring at your desk and tie each call to the ad or listing it came from. CallRail, one tracking vendor, says the administrator of the CallRail account authorizes moving a number to another provider (porting), that porting a US number away is free, and that it typically takes 4 to 6 weeks (CallRail, checked 2026-10-04). If the numbers sit in the agency's account, the agency is that administrator, so put porting on request into the contract.
What does the contract lock you into?
5. How long is the term, and what does leaving take? Read four lines: the first term, automatic renewal, the notice period, and the list of what you get back at the end. A good list names logins, domain, site files, tracking numbers and past reports, each with a date. Ask what happens to a setup fee if you leave early, and write any spoken promise into the contract.
What are you paying for, and who does the work?
6. How is the fee set, and what costs extra? The fee can be a flat monthly amount, a percentage of ad spend, or a price per lead. A percentage grows with the budget whether or not new patients do, and a price per lead pays for calls and forms, which are not patients. Ask for Google to charge the ad spend to the practice's card, so fee and spend never blur. Then ask for a written list of extras (landing pages, photos, call tracking, the website).
7. Who will actually do the work? Ask who, by name, will change your campaigns, and whether any work goes to another company. Then check it yourself. Change history in Google Ads (in the Campaigns menu) shows two years of changes, with the email of whoever made each one in the interface (Google, checked 2026-10-04).
What should the monthly report count?
8. What will the report count, and what do you need from my desk? Clicks, impressions (ad views) and leads measure the agency's activity; the result is new patients who came in. In Google Ads, leads appear as conversions, the actions the account is set to count, such as a call or a form (Google, checked 2026-10-04), and the ad report can count more of them than your records show.
The count that matters lives in your practice software, so the agency needs your front desk. Ask every new patient how they found you and pick the answer from a fixed list (Google, Facebook, insurance directory, friend, other). Mark each first visit arrived, and send the agency a monthly count, never names. I am a tracking specialist, not an agency, and this counting is the part I set up.
Illustrative: every number below is made up for an imaginary two-dentist general practice, and none comes from a client.
| What it counts | Where it lives | Made-up month |
|---|---|---|
| Ad spend | Google Ads billing | $4,000 |
| Agency fee | Agency invoice | $1,000 |
| Leads in the agency report | Agency report | 80 |
| New patients who said Google and came in | Practice software | 20 |
The report's cost per lead is ad spend ÷ leads: $4,000 ÷ 80 = $50. Your cost per new patient is (ad spend + fee) ÷ new patients who came in: $5,000 ÷ 20 = $250. "Said Google" also covers Maps and unpaid search, so the cost of a patient from the ads alone is likely higher; a phone line used only in the ads splits them out.
Now say the agency proposes raising ad spend to $8,000 a month. Today's $1,000 fee could be flat, staying at $1,000, or 25 percent of spend, rising to $2,000. To stay at $250 per new patient you then need ($8,000 + $2,000) ÷ $250 = 40 new patients a month on the percentage, or ($8,000 + $1,000) ÷ $250 = 36 on the flat fee. Ask the agency which number it expects, and by when.
Where can patient information end up?
9. Will patient details sit in your systems, and will you sign a business associate agreement? HHS lists dentists as covered entities, the providers HIPAA applies to, when they send information electronically in a transaction HHS has a standard for (HHS, checked 2026-10-04). Claims are one such transaction (CMS, checked 2026-10-04). HIPAA's Privacy Rule protects identifiable health information "whether electronic, paper, or oral" (HHS, checked 2026-10-04), so a recorded call in which a caller gives a name and a cracked tooth, or a form that asks for both, can hold it.
In HHS's terms, a business associate is engaged by a covered entity for work that involves that information. The practice needs a written business associate agreement (BAA) with it, and the business associate needs its own BAA with any subcontractor before passing the information on (HHS, checked 2026-10-04). Ask which of the agency's systems will hold patient details (call recordings, form entries, chat, online booking), whether it signs a BAA, and whether its vendors sign one with it. Take the answers to whoever handles HIPAA for your practice.
How will the agency get reviews?
10. How do you ask for reviews, and who replies? Google's rules prohibit offering incentives such as discounts for a review, and asking only the patients you expect to be happy (Google, checked 2026-10-04). The FTC's 2024 rule bans fake reviews and rewards conditioned on a positive or negative review (FTC, checked 2026-10-04). Replies carry their own risk: a California dental practice paid $23,000 to settle with HHS over patient information it disclosed in responses to online reviews (HHS, checked 2026-10-04).
Which answers are red flags?
| Question | A good answer | Red flag |
|---|---|---|
| 1. Google Ads account | Yours, with a practice login as admin | Only the agency can log in |
| 2. Business Profile | The practice is primary owner, the agency a manager | The agency is primary owner |
| 3. Domain and site | Domain in the practice's name, site files on exit | Domain in the agency's name, site rented |
| 4. Tracking numbers | In your account, or porting promised in writing | They stay with the agency |
| 5. Term and exit | Short term, written handover list | Auto-renewal, long notice, no list |
| 6. Fee | One written fee, spend billed to your card | Fee and spend in one unexplained bill |
| 7. Who does the work | A named person, visible in Change history | Nobody can say who logs in |
| 8. Report | New patients who came in, by source | Clicks, impressions and leads only |
| 9. Patient details | Each system named, a BAA where needed | No list, a promise instead of a BAA |
| 10. Reviews | Same request to every patient, replies that never mention care | Paid, filtered or ghost-written reviews |
Ask the ten in order on the sales call, and get the first six answers into the contract before you sign it.
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Frequently asked questions
Who should own the Google Ads account when an agency runs it?
The practice. Keep the account under a practice login with admin access and let the agency link its manager account. Google lets an admin unlink a manager account, and the account keeps its campaign history. If the agency pays Google for your ads through monthly invoicing, move the billing before you unlink, or the ads stop serving.
Can I keep my call tracking numbers if I leave my agency?
Yes, if the account that holds them is yours or its holder agrees to port them. CallRail, for example, says the administrator of the CallRail account authorizes moving a number to another provider, that porting a US number away is free, and that it typically takes 4 to 6 weeks. If the numbers sit in the agency's account, get porting on request written into the contract.
Does a dental marketing agency need to sign a business associate agreement?
HHS says a practice that is a covered entity must have a written business associate agreement with a business associate: an outside person or company it engages for work that involves protected health information. If the agency's call recordings, forms, chat or booking tools will hold patient details, ask for one, and ask whether its vendors sign one with the agency. An agency that only ever sees counts may not need one, so check with whoever handles HIPAA for your practice.
Should I pay a dental marketing agency a percentage of ad spend or a flat fee?
Either can work, but they move differently. A percentage of ad spend grows whenever the budget grows, whether or not new patients follow, while a flat fee stays put. Judge both the same way: ad spend plus fee, divided by the new patients from your ads who came in, counted in your practice software.
What happens to my website if I leave my dental marketing agency?
That depends on two things you can check before signing: who is the registrant of your domain, and whether the site runs on the agency's own platform. ICANN says a change of registrant goes through the current registrar, which typically confirms with the registered holder by email, so a domain in the agency's name needs the agency's yes. Ask for the domain in the practice's name and the site files handed over on exit.