Picture an owner whose dog died last month. She has been a client for nine years, so she's on the list you uploaded to Google. This week, while she reads the news, an ad for your practice shows up next to the story, and the page it opens is about euthanasia.
Nobody chose that pairing. Performance Max chose it, using a client list and a landing page that nobody told it to leave alone.
Performance Max is Google's most automated campaign type, and for a vet practice it can be one of the most useful. It can take your client list as a starting point, and a vet practice can share that list more freely than most medical practices. That freedom has limits, though, and one kind of page on your site sits right on the line. This chapter covers when to start Performance Max, what your client list can and can't do, and which pages to keep out of it.
Performance Max Comes After Search Has Proven Itself
Google describes Performance Max as a single campaign that can reach all of its advertising inventory: Search, YouTube, Display, Discover, Gmail and Maps. You supply the goal, the budget, the text, the images and some hints about your customers. Google decides where and when the ads run.
That kind of automation needs data to steer by, which is why our method never starts with it. A new vet account starts with the Search campaigns built in the earlier chapters, and those run for months first. Performance Max comes around months six and seven, once the Search campaigns are booking visits steadily and the account has real conversions to learn from.
When you build it, set the goal to conversions, the same booked visits and calls your Search campaigns count. Don't set a target cost per conversion at launch. Let the campaign learn what a visit costs in your market first, and add a target once you've seen a few weeks of results.
A Client List Is a Hint, Not a Fence
Performance Max takes what Google calls audience signals: lists and descriptions of the people you'd like to reach. Your client list is the best signal a practice has, because it shows Google exactly what a real client looks like, not a guess.
But a signal is a starting point, not a boundary. In Google's words, "Performance Max may show ads to relevant audiences outside of your signals if they have a strong likelihood of converting." The list tells Google where to begin. It doesn't stop the campaign from reaching new owners, and that's the point: the owners who look like your best clients but haven't found you yet.
Size matters here. Google says a list needs "more than 1000 active and eligible users" to work as a signal. A practice with a few hundred clients on file may not get there, and a larger practice should upload its full active list rather than a hand-picked slice.
A Vet's Client List Isn't Health Data. A Dentist's Is.
Here vet practices have an advantage most medical practices don't. A dental or medical practice's patient list is protected health information under HIPAA, and Google blocks client lists outright for ads about invasive procedures such as implants and oral surgery. Those practices build Performance Max largely without their own data.
HIPAA covers people, not pets. A 2019 article in the AVMA's journal says it plainly: "the federal Health Insurance Portability and Accountability Act does not apply to animals." And Google's health rules are written around a person's own health, not a pet's. For wellness exams, vaccines, dental cleanings and spay and neuter surgery, a vet practice can generally use its client list in Performance Max.
Google's own rules for client lists still apply to everyone. Under its Customer Match policy:
- The data has to be yours. You can only upload information customers shared directly with you, such as at registration or checkout.
- Your privacy policy has to say so. It must disclose that you share customer data with outside companies that provide services for you.
- The list has to stay fresh. Entries expire after 540 days, and a list needs at least 100 members added or updated in that window to stay eligible.
Get the Client's OK Before the List Leaves the Building
HIPAA isn't the only privacy law, and this is where vet practices need care. Client records are protected by state law, and the states don't agree. The same AVMA journal article notes that "there is no national standard, and state laws range from strict to limited regulation of disclosures."
California sits at the strict end. Its veterinary law prohibits disclosing "any information related to a patient, a client, or the veterinary care a patient has received without informed client consent." The AVMA's own ethics principles say medical records "must not be released except as required or allowed by law, or by client consent."
Uploading a client list to Google shares client information with an outside company. The safest way to handle it is the simplest: add a line to your new-client form saying the practice may share contact details with advertising partners to show relevant messages, and have existing clients confirm it at their next visit. Then upload only the clients who've agreed.
Rules differ by state, so have someone who knows yours review the wording before you rely on it. (Use this as a checklist to discuss, not as legal advice.)
Performance Max Picks Landing Pages You Never Chose
The second risk has nothing to do with lists. It's about where the ad sends people.
Performance Max comes with a setting called Final URL expansion, and Google's help page confirms that it starts switched on in every new campaign. It lets Google swap the landing page you chose for any other page on your site that it thinks fits the search better. Google's own caution: it "can sometimes lead to ads pointing to unintended pages."
On most sites that means an owner lands on a services page instead of the home page, which is fine. On a vet site it can mean an ad lands on a page you'd never want to advertise, for reasons that go beyond performance.
You can turn the expansion off, which limits the campaign to the pages you list. If you leave it on, the answer is URL exclusions: a list of pages, or rules covering whole sections of the site, that the campaign may never send traffic to. One detail from Google's help page worth knowing: the campaign's own final URL can't be excluded, so the page you set as the main destination will always serve.
Keep Euthanasia Pages Out of It
Almost every vet practice has at least one page about end-of-life care. One example-market practice lists a compassionate euthanasia page among its services; another offers end-of-life care from its emergency page. Those pages matter to owners, and they belong on the site. They don't belong in a campaign built on a client list.
Google treats grief as sensitive. Its policy on relationship hardships lists "Bereavement products or services" as a sensitive interest category, and for that category, advertiser-curated audiences "can't be used," Customer Match included. Our reading: a Performance Max campaign that uses your client list and then sends owners to a euthanasia or pet-loss page puts the two together, and that's exactly what the policy rules out.
The fix takes a few minutes:
- Exclude every end-of-life page. Euthanasia, hospice, aftercare and cremation, pet-loss support, and any memorial or grief resources. Use a rule if they share a section of the site.
- Check again when the site changes. A new blog post about saying goodbye is a new page Performance Max can find.
- Give end-of-life care its own campaign. If your practice wants to advertise euthanasia or hospice, do it in a separate Search campaign with no audience lists at all. Chapter 15 covers how.
There's a second step, and it's about people rather than pages. Before each upload, remove owners whose pet has died recently from the client list. Google's policy already bars ads that imply you know sensitive information about a customer, and your ads won't mention a pet by name. But an owner in her first weeks of grief doesn't need to see a cheerful wellness ad from the practice where she said goodbye. If your practice software marks patients as deceased, use that field to filter them out when you export the list.
Brand Exclusions Keep Performance Max Off Your Own Name
An owner who types your practice's name into Google is already coming to you, but Performance Max will still bid on that search unless you stop it. Those owners were going to find you anyway, and your brand campaign from Chapter 9 already catches them. Google's answer is brand exclusions: build a brand list with your practice's name and your veterinarians' names, then apply it to the Performance Max campaign so branded searches stay in the brand campaign.
The rest of our setup:
- Build custom segments first. Before the campaign, create segments from the searches owners make when they need a vet, and from up to 20 competitor websites. These describe the kind of person to find. They aren't remarketing.
- Target by Presence, the same as in Chapter 9, so ads reach owners who live in or regularly visit your area.
- Skip the AI-generated text and images. Bring in your best-performing headlines from the Search campaigns instead, the ones Chapter 8 taught you to write from owner reviews.
- Use real photos and video. Your team, your exam rooms, real patients with their owners' permission. If you don't supply a video, Google may make one from your images, and it rarely looks like your practice.
Next: Win Back the Clients Who Skipped Last Year's Checkup
Performance Max finds new owners who look like your clients. Chapter 11 turns to the clients you already have: the ones who haven't been in for a year, and how Demand Gen campaigns on YouTube and Gmail can bring them back.
The whole guide is on the Google Ads for Veterinarians guide home. And if you'd like help setting up Performance Max without the risks above, it's part of what our Google Ads management does for vet practices.
