Attribution You Can Trust: Connecting Ads to Appointments & Signed Cases

Why attribution breaks in professional practices

If you’ve ever looked at your ad reports and thought, “These numbers don’t match our schedule or signed cases,” you’re not alone. In healthcare and legal services, the conversion doesn’t happen on a checkout page—it happens on the phone, in intake, or after a consult. That means the key touch points live offline, inside call recordings, EHR/CRM notes, and front-desk workflows.

Good news: with a few process upgrades, you can tie spend to real outcomes—appointments shown and cases signed—so you can invest confidently and cut waste.

The end state: a simple, trusted pipeline

Traffic → Lead (call/form/chat) → Qualified (right service/location) → Booked (appointment/consult) → Showed → Signed/Started → Review/Referral

At each stage, you’ll (1) capture the source/medium/campaign, (2) record the outcome, and (3) sync it back to your analytics and ad platforms—so your numbers agree.

Step 1: Standardize your tracking links (so source data is clean)

Before you fix attribution, fix the plumbing.

UTM standards: Create one sheet with approved UTM parameters for each channel (Google Ads, Meta, Local Listings, Email, Display, Referral partners).
- utm_source, utm_medium, utm_campaign, and optional utm_content for A/Bs.
Landing pages: Point paid traffic to service- and location-specific pages with clear CTAs (call + form).
Call tracking: Use dynamic number insertion (DNI) so calls inherit the same UTMs as where they came in from.
Forms & chat: Pass UTMs into hidden fields and store them with the lead record.

Outcome: Every new lead enters your system with a trustworthy source/medium/campaign attached.

Step 2: Capture every call and form (and who they become)

Call recording & attribution: Record calls, capture caller ID, first-touch UTMs, and session pages.
Form & chat: Collect and store the full contact information and details (service interest, location, insurance/retainer fit, notes).
Deduping: Deduplicate by phone/email so repeat contacts roll up under one contact ID.

Outcome: One person, one history, one source—the foundation for reliable downstream attribution.

Step 3: Offline conversion imports—closing the loop to ad platforms

Ad platforms only see clicks and online forms by default. To optimize off of booked appointments and signed cases, send those outcomes back as offline conversions.

Google Ads:

Map your CRM/EHR fields to Google’s required schema (GCLID/GBRAID/WBRAID when available, lead timestamp, conversion name, value).
Store the click IDs (GCLID, etc.) at the moment the lead is created (from forms or call tracking).
When the lead reaches a milestone (Booked, Showed, Signed), upload a conversion with the original timestamp, conversion time, and optional value.
Automate daily uploads via API or secure file feed.

Pro tips:

Choose conversions that reflect true business value (e.g., Consult Booked and Case Signed/Pt Started).
Set appropriate conversion windows (often longer in legal).
Start broad, then layer in value-based bidding once you have enough volume.

Outcome: Algorithms optimize for the outcomes you actually care about—not just clicks and leads.

Step 4: Tag call outcomes (so you know what worked)

Most leakage happens on the phone. Tagging the results of phone calls turns “lead volume” into “business results.”

Potential tags for calls:
- Qualified — Booked (wins)
- Qualified — Not Booked (lost to timing/price/competition)
- Unqualified (wrong service/insurance/geo)
- Spam/Missed (automation opportunity)
Team scripting: Provide a one-page script with three goals: qualify, schedule, and request review.
Automation assist: Missed calls trigger an immediate text + online scheduling link.

Outcome: You’ll see exactly which campaigns generate bookable inquiries—and where to coach or automate.

Step 5: Carry source/medium into the EHR/CRM (and keep it there)

If your source data disappears after the lead stage, reporting breaks. Make Source, Medium, and Campaign required fields that persist from lead → appointment → treatment/case.

Custom fields: Create locked fields for Source/Medium/Campaign/Keyword.
Write-once logic: First-touch fields are write-once; last-touch fields can update.
Stage mapping: Ensure every status change (Booked/Showed/Signed) retains the same IDs.
User training: Add “Select/update Source” to your intake checklist.

Outcome: Downstream revenue reports can be segmented reliably by acquisition source.

Step 6: Find a simple “Cost-to-Acquire” dashboard in the Success Center

You don’t need 40 charts. You need one scoreboard everyone trusts.

Core metrics:

Spend (by channel/campaign)
Leads (calls + forms)
Booked (consults/appointments)
Shows
Signed/Started
Revenue (optional if available)

ROI that matters:

CPL = Spend ÷ Leads
Cost per Booked = Spend ÷ Booked
Cost per Started/Signed (CAC) = Spend ÷ Signed/Started
Show Rate = Shows ÷ Booked
Close Rate = Signed/Started ÷ Shows

Breakouts to include:

Channel → Campaign → Keyword/Creative
Service line and location (essential for multi-location groups)
New vs. returning patients/clients (if you run retention campaigns)

Cadence:

Weekly 20-min review: focus on outliers and actions (pause, shift budget, coach intake, update ad copy).
Monthly: rebaseline targets, roll up to profit view.

Outcome: Everyone rallies around CAC and the steps that improve it.

Step 7: Make it operational (so it sticks)

Owner: One marketing lead owns UTMs and ad hygiene; one operations lead owns intake tagging and CRM data integrity.
SLAs: Response time targets (e.g., <5 minutes for new leads) and voicemail/text backup.
QA: Randomly review 5 calls/week for script adherence (give constructive support as neeed) and correct outcome tagging.
Change log: Document naming conventions and any tracking changes to keep reports clean.

What good looks like in 60 days

Ad platforms optimize to Booked and Signed/Started events
Intake tags every call outcome; missed calls auto-follow up
Source/Medium/Campaign are present on patient/case records
The Success Center shows CAC by channel/service/location
Budget shifts are based on cost per signed case/patient, not hunches

Ready to tighten your loop?

Whether you’re a current MyAdvice client or exploring options, we can help implement offline conversions, intake tagging, and a clean CAC dashboard without rebuilding your stack. If you’d like a quick audit of your pipeline and tracking, book a consult—we’ll show where the gaps are and how to close them fast.