A dermatology practice can do everything else in Google Ads right and still lose the account at the scheduler. The ad runs, the patient clicks, the patient books a skin check for next Tuesday, and Google never finds out. As far as the account can tell, that click was a waste of money. Do that a few hundred times and Google starts steering your budget away from the searches that were filling your schedule.
This is the first chapter of our guide for dermatology practices because nothing later works without it. Keywords, bids, Performance Max and every automated feature in the second half of the guide all run on one input: the conversions you record. So before a single keyword goes live, we settle what counts as a booking, where each booking happens, and what Google is and isn't allowed to know about it.
Google Learns Only From the Bookings You Let It See
Conversion tracking does two jobs. The obvious one is reporting: which campaigns and searches bring in new patients, and which only bring in invoices.
The second job is the one that decides where your money goes. Google's automated bidding treats each recorded conversion as an example of what you want, then goes looking for more people like the ones who converted. Chapter 6 introduces Exploration, BrandRocket's name for a broad-match campaign that goes hunting for dermatology searches nobody put on the keyword list. It depends on these bookings, and so does everything built after it.
So there are two ways to get tracking wrong. You can undercount, and Google learns that your best searches don't work. Or you can count the wrong things, and Google gets very efficient at finding people who were never going to book. Plenty of accounts do a little of both.
Where a Dermatology Booking Finishes Decides What Google Can Count
Start by finding where a new patient actually commits. On most dermatology sites that moment happens inside scheduling software, and the software decides how much Google can see.
We looked at 12 websites run by 11 Atlanta practices that were buying Google Search ads this month, ten dermatology practices and one med spa. Their booking setups fell into three groups.
The booking finishes on another company's website. Five of the 12 send the patient to a scheduling page hosted by the software vendor: Nextech's MyPatientVisit on two sites, plus Healow, ModMed and Zenoti. Springs Dermatology in Sandy Springs, for example, offers a "Schedule Now" button that opens Healow, the booking tool that comes with its records system. It is a clean experience for the patient. For Google, the trail ends the moment the patient leaves your domain, because your tracking code doesn't run on the vendor's page.
The booking finishes on your own site, inside an embedded widget. Five more embed the scheduler in their own pages, using tools such as NextPatient, Phreesia and Tebra. Olansky Dermatology's widget, for instance, lets the patient pick an office and a service type without leaving the site. This setup gives you the best chance of counting the booking itself, because the confirmation can happen on a page you control.
There is no online booking at all. Two practices take requests by form, phone or email. Here the conversion is the form submission or the call, and someone at the front desk knows which of those became appointments.
For each setup, ask your scheduling vendor two questions. Can it fire your Google tag, or send an event you can track, when a booking is confirmed? And can it keep the Google click ID attached as the patient moves from your site to its booking page? If the answer to both is no, you still have options: count the click on "Book Now" as a secondary signal, and bring confirmed new-patient bookings back into Google Ads later from your own records. When patients move between two domains you control, Google Analytics has a setting called cross-domain measurement, which Google says "allows activity to be accurately attributed to a single user as they cross domains."
Portal and Bill-Pay Clicks Look Like Leads. They Are Existing Patients.
Here is a trap that is easy to miss on a dermatology site. Your website is also the front door for patients you already have.
On 10 of the 12 Atlanta sites, the patient portal, prescription refill requests or bill pay link out to another company's domain. That matters because a common shortcut in Google Ads is to count "clicks to an outside booking site" as conversions. On a dermatology site, that rule would also count every established patient paying a bill, checking lab results or asking for a refill.
Those people are valuable to the practice. They are not what your ads are for. If Google learns from them, it learns to find people who already have a dermatologist, which is the least useful thing it could learn.
The fix is simple once you see it. Count only the actions a new patient takes: the booking confirmation, the new-patient form, the first call. Leave portal, bill-pay and refill clicks out entirely. Some practices already make this easy. Dermatology Consultants splits its homepage into "New Patient Appointments" and "Existing Patient Appointments," which is exactly the fork your tracking needs.
One Phone Number Can't Tell a Mohs Call From a Botox Call
Every site we checked lists a phone number, and phone calls are where dermatology tracking gets blurry fastest.
Three of the seven multi-office practices we checked publish one number for every location. Others route calls through a phone menu, with cosmetic appointments on one option and Mohs surgery on another. That works well for the front desk. In the ad account, it means a call from your cosmetic campaign and a call from your skin cancer campaign look identical once they reach the menu.
A practice with one campaign and one phone line can rely on the call tracking built into Google Ads. It swaps in a Google forwarding number on your ads and site and records calls that last longer than a minimum length you choose. Once you run medical and cosmetic campaigns side by side, you need a separate tracked number for each, which usually means a call-tracking service. HIPAA-compliant options exist; check that any vendor will sign a business associate agreement before you connect it. In our Atlanta sample, only 3 of 11 sites showed a call-tracking script in their page code (others may load one in a way that check can't see).
Set the minimum call length to 30 seconds. Google's default is 60, according to its developer documentation, and that cuts out real patients. A patient who reaches voicemail on a Friday afternoon and leaves a 40-second message asking about a changing mole is exactly the lead you paid for.
The Scheduler Asks Why the Patient Is Coming. Google Never Gets That Answer.
Dermatology schedulers ask a lot. Visit type, visit reason, new or established patient, insurance plan. The practice needs every one of those answers. Google needs none of them.
What Google should receive is the fact that a new-patient booking happened, and when. Not the reason for the visit, not the condition, not the insurance plan, not the patient's name. Two sets of rules push in the same direction.
Google's customer data policy puts health information, including the purchase of medical services, on its list of sensitive categories, and it bars conversions in those categories from enhanced conversions. Enhanced conversions is the feature that sends hashed customer details such as email addresses to Google to improve matching. For a medical booking, the policy takes it off the table, so don't switch it on by default the way many setup guides suggest.
Federal guidance points the same way. The Department of Health and Human Services has said that tracking technologies on a public page "that permits individuals to schedule appointments" without logging in "may have access to PHI in certain circumstances." PHI is protected health information. A federal court vacated part of that guidance in June 2024, the part about public pages that only discuss conditions, but the booking and reason-for-visit pieces were not part of what the court struck. Google, for its part, won't sign a business associate agreement for Google Analytics, and its help center tells health providers to keep Analytics off pages HIPAA likely covers, such as logged-in portal pages.
In practice: keep Google's tags off the patient portal, keep visit reasons and conditions out of every event name and URL that reaches Google, and have counsel review the booking flow before you connect anything. This is a place for your lawyer, not a blog post. (Nothing in this chapter is legal advice.)
Six Settings That Turn a Booking Into Something Google Can Learn From
Once you know what to count, a handful of settings decide how Google uses it.
Primary or secondary. Mark new-patient bookings, new-patient forms and qualified calls as primary. Primary actions feed bidding. Anything else you want to watch, such as clicks on "Book Now" when you can't see the confirmation, goes in as secondary; Google says a secondary action "is excluded from the 'Conversions' column used for bidding optimization but is tracked and reported in the 'All conversions' column."
Count one. A patient who books and then calls to confirm is one new patient, not two. Google recommends counting one conversion per click for leads: "This is a good choice if you're not interested in the number of sales, but instead whether or not a certain kind of lead was generated."
Conversion window. Google lets you set the click-through window from 1 day up to 30, 60 or 90 days, depending on the conversion source, with 30 days as the default. Dermatology appointments are often booked weeks out, and some patients click, think about it, and book later. We usually lengthen the window for booking and form actions rather than accept the default.
Attribution. Use data-driven attribution, which spreads credit across the searches that led to a booking instead of handing all of it to the last click.
Call length. 30 seconds, as above.
The leftover checkbox. Some conversion forms still show an enhanced CPC option, a retired bidding feature. Leave it unchecked.
Install everything through Google Tag Manager, so tags live in one place instead of scattered through the site's code, turn on auto-tagging in the Google Ads account, and test every action in Tag Manager's preview mode before the first ad runs.
Page Views Counted as Conversions Are Teaching Google the Wrong Patient
If the account is already running, open the list of conversion actions before you change anything else. The usual suspects are page views: someone reached the contact page, the Mohs page or the gallery, and the account called it a conversion. Portal clicks turn up too. We find old actions from an agency two agencies ago, still firing.
Each of those is a lesson Google is still learning from. A visit to the Mohs page is interest, not a patient. When page views sit in the primary column next to real bookings, Google can't tell them apart, and it happily buys more of whichever is cheaper to get. The cheaper one is almost always the page view.
Remove them, or move them to secondary, before launch. If the account's history is built mostly on bad actions, it can be worth starting the conversion data over rather than asking Google to unlearn it. It feels like losing history. It is really losing bad habits.
Next: Most Skin Searches Are Questions, Not Appointments
With bookings, forms and calls counted correctly, the account can finally learn from real new patients. The next question is which searches to show up for in the first place. Someone typing "melanoma symptoms" and someone typing "dermatologist near me" are at very different points, and Chapter 2 maps those stages and where Google Ads should meet a patient first.
The Google Ads for Dermatologists guide home lists all fifteen chapters in the order we build them.
When a practice hires us, this is week one: the tracking gets rebuilt before a single keyword runs. Every dermatology account under our Google Ads management starts there. If you would rather do it in-house, work through this chapter in order.
