If your conversion rate is over 100%, your reporting is lying to you

A conversion rate is conversions divided by clicks. For it to climb past 100%, the account has to be recording more conversions than there were clicks. That is only possible when the thing being counted is not a single, real, new patient booking. The usual culprit is that someone set a page view as a conversion. Every time a visitor lands on the Contact page, the booking page, or a thank you page that reloads, Google logs another conversion. One person can trigger three or four of those in a single visit.

I audited an account last year that was reporting a 148% conversion rate. The owner thought the agency was working magic. When I opened the conversion actions, the primary action was a page view of the Contact page. People were clicking around the site, viewing the contact details, sometimes refreshing, and each view counted. The campaign was not booking anyone. It was counting curiosity. This is the same confusion I unpack in conversion versus conversion action: the platform will happily call anything you tell it a conversion, whether or not a patient ever walked through your door.

Once you know what to look for, the inflation almost always comes from the same three sources. Each one quietly pumps up the conversion count and pushes the reported cost per booking down to a number that looks fantastic and means nothing.

Page views are the first. Counting a visit to the Contact page, the booking page, or a generic thank you reload treats interest as outcome. Rebookings from existing patients are the second. If your booking page fires the same conversion whether it is a brand new patient or someone who has seen you eleven times already, your data mixes acquisition with retention and you can no longer tell what new patients actually cost. Brand clicks are the third. People searching your clinic name were going to find you anyway, so counting their bookings as paid wins is a story you tell yourself, not a result you earned.

The pattern is consistent enough that I can usually guess the fault before I open the account. When a cost per booking looks too good to be true, it is.

Here is the test I apply to every conversion action I keep. An honest conversion counts a patient you would not have won without the spend. A new person, with a problem, who found you through a paid search, who would otherwise have gone somewhere else. That is the only number worth optimising toward, because that is the only number tied to growth.

Everything else is noise dressed up as a win. A returning patient booking their next appointment is great for your business, but it is retention, and it would have happened without a single ad dollar. A page view is interest. A brand click is something you already had. None of them belong in your acquisition cost. When you measure only genuine new patient bookings, the number on the screen gets bigger and uglier, and for the first time it is true. A healthy physio account in Australia lands around $80 to $100 per new patient booking, and the gold standard band across allied health bottoms out near $65. If your dashboard is showing you $18, you are not beating the benchmark. You are not measuring the same thing.

The brand inflation deserves its own mention because so many accounts do it on purpose. Running a branded campaign, or letting brand searches funnel into your conversion data, buys clicks from people who typed your clinic name into Google. They were already coming. I never run branded campaigns and I would steer you away from them too, for exactly this reason. It is covered in more depth in why you should stop bidding on your own brand name.

The damage is double. You spend budget on traffic you would have captured for free through your Google Business Profile and organic listings, and then those near certain bookings get folded into your paid conversion data, dragging your reported cost per booking artificially low. You end up paying to make your own reporting lie to you.

You do not need an agency to spot most of this. Open your conversion actions in Google Ads and read what each one is actually tracking. If you see anything that is a page load rather than a completed booking, that is your first leak. If your booking confirmation cannot distinguish a new patient from a returning one, that is your second. If brand searches are feeding the same campaign, that is your third.

Then go a layer deeper and look at whether your booking page even confirms bookings cleanly, because half the tracking faults I find start with a website that does not register a booking properly in the first place. Fix the measurement before you touch the bids. A campaign optimised against a fake conversion rate will keep pouring money into whatever inflates the fake number, which is usually the worst traffic you have.