Google Ads
Your ads are getting clicks. Where are the bookings?
We tried Google Ads and it didn't work. I hear it every week. Here is the diagnosis those accounts never got, in the order it has to run.
By Pete Flynn · 13 July 2026 · 9 min read
A clinic owner told me last month that Google Ads doesn't work for physio in her area. She'd spent $4,000 over three months, the dashboard showed 61 conversions, and the front desk could not point to a single patient who came from the ads. Every part of that sentence matters, because it means nobody ever actually diagnosed the account. Sixty one conversions and no patients is not an advertising problem. It is a measurement problem wearing an advertising problem's clothes.
I'm a physio who owned and sold his own clinics, and these days we run Google Ads for over 120 Australian clinics. When an account underperforms, we run the same checks in the same order, every time. The order is the whole trick. Most people start at the bottom of the list, fiddling with bids and rewriting ads, when the account is failing three levels above where they're looking.
This article is that diagnosis. Run it on your own account before you decide Google Ads doesn't work in your suburb. In my experience, it works in your suburb. Something specific is broken, it has a name, and it is probably one of these seven.
The triage ladder
Check in this order. Most accounts fail at step one or two.
The meter
Start hereConversion tracking counts real bookings and nothing else.
The report says conversions but the phone is quiet.
Ads actually serving
Start hereEvery campaign approved, live and spending as planned.
Disapprovals sitting unnoticed, or an ad group quietly dark.
Where the money goes
Search terms match the patients you actually treat.
Jobs, courses and suburbs you do not serve eating the budget.
Winners fed
Your best campaign gets every dollar it can profitably spend.
The best campaign capped by budget while weak ones spend freely.
Ads earn the click
Ads tested against each other, losers replaced with new ideas.
One average ad running unopposed for months.
Landing page keeps the promise
An ad about heel pain lands on a page about heel pain.
The ad promises heel pain help, the page is a generic homepage.
Bidding asked to do magic
Smart bidding fed real booking data it can actually learn from.
Smart bidding left to guess with no real conversion data behind it.
The whole point
The order matters. A perfect ad cannot fix a broken meter.
Nine times out of ten, it is not the ads
The first check is always the meter, never the engine. Before you judge a single keyword, you have to know whether the account's conversions are real bookings or soft signals dressed up as results: page views, button clicks, 'someone looked at the contact page'. A campaign optimising toward fake conversions gets very good at buying fake conversions.
This is not a rare edge case. It is the most common broken thing we find, and it poisons everything downstream. Smart Bidding learns from the conversion data. The reports score campaigns on it. Your decisions about what to pause and what to feed all inherit its errors. If the meter is wrong, every other number in the account is fiction with a decimal place.
The test takes one phone call. Ask your front desk how many new patients this month mentioned finding you on Google, then compare it to what the dashboard claims. If those two numbers are strangers, stop here. Fix tracking first. Nothing else you change can be trusted until you do.
Most 'Google Ads doesn't work' stories are true stories about a broken meter.
Tell me what you're seeing
If you want the shortcut, describe the symptoms and let the pattern matching do the work. Tick what you recognise below. It is the same triage we run on a new account, minus the two hours in the campaign settings.
Ads symptom checker
Which of these sound familiar?
Tick everything you recognise from your own account. Most of these symptoms point back to one or two root causes, and the checker will tell you which ones to look at first.
Tick the symptoms you recognise to see the most likely cause.
The full triage, in order
Here is the complete sequence, and the order is not decorative. Each check assumes the ones above it passed. Rewriting ad copy while your budget flows to job seekers is polishing the menu in a restaurant with a gas leak.
Seven checks, in the order they must run
Check 1
The meter
Do the account's conversions match real bookings the front desk can name? If not, nothing below this line means anything yet.
Check 2
The ads are actually showing
Disapprovals, paused ads, and ad groups down to zero enabled ads all fail silently. An ad group with one ad is a disapproval away from going dark without telling you.
Check 3
Where the money goes
Open the search terms report. If the budget is buying job seekers, students and suburbs you do not serve, the campaign needs a proper negative keyword system, not new ads.
Check 4
The winner is being fed
Check whether your best converting campaign is capped by budget while weaker campaigns spend freely. Accounts starve their winners out of politeness constantly.
Check 5
The ad earns the click
Two enabled ads per ad group, competing, judged on bookings. One average ad running unopposed for months is the quietest leak in the list.
Check 6
The landing page keeps the promise
An ad about heel pain that lands on a generic homepage breaks the chain at the last link. The page has to continue the sentence the ad started.
Check 7
Only now, bidding
Bidding strategy is the last check, not the first, because Smart Bidding is only as smart as the conversion data feeding it. Fix the data, then ask the robot to optimise.
What happens when the diagnosis runs in order
The reason I keep hammering the order is that the early checks change the meaning of the late ones. Fix tracking and last month's 'winning' campaign sometimes turns out to be the loser. Clean the search terms and your cost per booking can drop by a third without a single new ad being written. The account you judge at the end of the sequence is a different account from the one you started with.
It also changes the emotional story. 'Google Ads doesn't work for us' is a dead end. 'Our tracking was counting button clicks, our budget was leaking to job ads, and our best campaign was starved' is a repair list. Every item on it has a fix with a known shape, and none of the fixes is 'spend more'.
And if you run all seven checks and everything genuinely passes? Then we have an honest conversation about whether your suburb's numbers support the maths at all. That conversation is real, but I have it far less often than you'd think. The diagnosis usually finds the leak long before we get there.
Want the diagnosis done properly?
We run this exact triage on your real account and show you what's broken, in plain English.
Tracking, serving, search terms, budget flow, ad copy, landing pages, bidding. Every number pulled from your account, nothing invented, and you keep the findings whether we work together or not.
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