You pay for Google Ads and cannot tell whether the account is in good shape. You can check the basics in about an hour, with read-only access, and the first thing to read is what the account counts as a conversion.
Quick answer
- Confirm you can open the account yourself, with at least Read only access.
- Open the Conversions summary and read what is counted as a result.
- Read the last 30 days of search terms for jobs, "free" and other cities.
- Check ads for Eligible (limited) or disapproved, and campaigns held back by budget.
- Compare the conversion count with booked new patients for the same month.
What does the hour look like?
Order matters here. Without access you are relying on screenshots, so it comes first. Every later number depends on conversions, so they come second.
I put conversions early for a reason. I bought Google Ads and Meta Ads from October 2023 to September 2025, nearly $700K in cumulative spend. Bidding follows whatever the account counts, so I read that setting before any ad.
Can I look without risking the account?
Yes. Ask for Read only access under your own Google login. Google's access table lets that level view campaigns and run performance and billing reports, but not edit campaigns.
To add you, the person with Admin access goes to Access and security in the Admin menu and sends an invitation. Admin is the level that can give account access and change access levels. If you do not know who holds it, that is your first finding.
What does the account count as a conversion?
A conversion is any action the account was told to treat as a result, and Google bids toward it. Open it now. It takes ten minutes.
- In Google Ads, open Goals, then Conversions, then Summary.
- List every action. Mark which are page views, phone taps, form sends or booked appointments.
- Check each action's setting. Primary actions appear in the Conversions column and are used for bidding. Secondary ones are observe only.
Then read the Status column. Google is gradually rolling out five statuses: Active, Needs attention, Misconfigured, Awaiting conversions and Removed. Until they reach your account, it may show older labels such as Unverified; my post on each status and its fix covers both sets.
A healthy answer is one primary action that means a real inquiry. A page view of a "thank you" screen can be fine; a visit to a contact page is not.
Why can the conversion count mislead me?
Because the account optimizes for the count, not for patients. If cheap actions get counted, the system finds more of them.
Illustrative: every number below is made up for an imaginary dental practice, and none comes from a client.
| Item | Source | Made-up month |
|---|---|---|
| Ad spend | Billing | $4,800 |
| Conversions in Google Ads | Conversions column | 120 |
| Of those: phone taps / form sends / contact page views | Conversions summary | 52 / 38 / 30 |
| New patients booked | Practice management system | 16 |
- Cost per conversion: $4,800 ÷ 120 = $40.
- Cost per booked patient: $4,800 ÷ 16 = $300.
The report shows $40, but a patient costs $300. If the bidding aims at $40 per conversion, it treats each of the 30 contact page views like a patient and looks for more of them. For the full gap between the two counts, read why Google Ads conversions and CRM leads differ.
Who is actually searching?
Open Campaigns, then Insights and reports, then Search terms. It lists what people typed before your ad showed. Scan 30 days for four types:
- Job seekers: "dental assistant jobs".
- Price hunters: "free", "cheap", "low cost".
- Other cities, or other specialties you do not offer.
- Your own practice name, which flatters results.
Irrelevant terms belong in negative keywords, words that keep your ad from showing for a search. Google says you can't add them directly from the report, so ask who maintains the list.
Then open campaign settings and read the location option. Presence or Interest reaches people in your area and people who showed interest in it, and Google recommends it on Search. Google suggests Presence when you only want people in your locations. Ask which one your campaigns use, and why.
Are the ads allowed to run, and is budget holding them back?
Open Campaigns, then Ads, and read the Status column. Eligible (limited) means the ad can run, but not in all situations. Disapproved means it can't run.
A limit on a health ad is not always a problem. Add the Policy details column to see which rule applies. If it names Health in personalized advertising, the ad can't use audiences you built, such as Customer Match lists. The health policy post explains which labels need action.
Budget has its own label. Limited by budget in the campaign Status column means the daily budget is below what Google recommends. Ads may still show, but less often than they could. Ask whether that is on purpose or an accident.
Should I trust the Optimization score?
Use it as a prompt and nothing more. Google defines it as an estimate of how well your account is set to perform, from 0% to 100%. Nothing in that definition mentions booked patients.
Also find where auto-apply is set. In Recommendations, the setting is labeled Automatically apply recommendations. If it is on, the History tab there lists what was applied.
Last, open Campaigns, then Change history, and read the past 30 days. It keeps two years of changes, and the User column shows the email of whoever made each one. Look for budgets, targets and conversion settings.
What does each check cost if it is wrong?
| Check | Where to look | A healthy answer | If wrong |
|---|---|---|---|
| Access | Admin, Access and security | You hold Admin or Read only | You cannot check or keep it |
| Conversions | Goals, Conversions, Summary | One primary action = a real inquiry | Bidding chases cheap actions |
| Search terms | Campaigns, Insights and reports | Mostly people who need your service | Money goes to jobs and "free" |
| Locations | Campaign settings | Option matches your service area | Clicks from people who cannot visit |
| Ad status | Campaigns, Ads, Policy details | Each limit has a known reason | Ads run less than you assume |
| Budget | Campaigns, Status column | Limit is chosen on purpose | Ads show less often than they could |
| Recommendations | Recommendations | Auto-apply is a decision | Changes you never approved |
| Change history | Campaigns, Change history | Each change has a known author | Edits nobody can explain |
For Performance Max, the channel performance report under Insights and reports shows cost and conversions by channel, such as Google Search, YouTube and Maps. For Display, Where ads showed lists sites and apps, though Google says it is not a complete list.
What should I ask my agency?
- Who owns the account, and can I be an Admin?
- What counts as a conversion, and why that action?
- Can I see the last 30 days of search terms?
- Can you open the change history with me?
- How do you know a conversion became a patient?
If the answer to the last question is "we don't", the fix is to track the booking itself, not to tune the ads further.
Sources checked on 2026-10-23.
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Frequently asked questions
Does Google Ads have a health check feature?
I found no feature with that name in Google's help pages. What exists is Recommendations and the Optimization score, which Google calls an estimate of how well the account is set to perform. Treat the score as a prompt to look. It is not a verdict on patients.
What is an account audit?
It is a structured look at how an ad account is set up and what it spends money on. For an owner, the useful version asks four things: who controls the account, what it counts as a result, which searches it pays for, and what changed lately.
Should I turn on auto-applied recommendations?
Decide it on purpose. Do not leave it at the default. Google lets you pick which recommendations apply automatically in the Recommendations section, under the setting called Automatically apply recommendations. Ask who chose the current setting and what has been applied so far.
How far back does Google Ads change history go?
Two years. Google says data older than that won't be available. Open Campaigns, then Change history; the User column shows the email of whoever made each change, and automatic changes appear under names such as Google Ads system.
Can Read only access change my campaigns?
No. In Google's access table, Read only can view campaigns and run performance and billing reports, but it cannot edit campaigns. Admin is the level that gives access and changes access levels, so the Admin has to invite you.
Written by
Marketing Analytics & Conversion Tracking Engineer, US and Canada, run remotely
- Media buyer on Google Ads and Meta Ads from October 2023 to September 2025, nearly $700K in spend.
- Set up patient conversion tracking for a New York medical practice (anonymized).
- Upwork Top Rated Plus, 5.0 from 20 reviews.