The four questions
How many patients attended? Not leads, not enquiries — people who sat in a chair. What did each one cost? Total spend, including the provider's fee, divided by that number. Which creative and audience produced them? If nobody can say, the campaign cannot be improved, only repeated. What are you changing next month, specifically? A provider with no answer is maintaining, not managing.
Send those four in writing and give a deadline. The quality of the reply tells you more than any portfolio, and the exercise costs you nothing.
Selling products or courses alongside the clinic?
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The three places money actually leaks
The reply. Ads deliver an enquiry to a phone nobody answers until tomorrow. This is the most common leak by a distance and it is not the agency's fault. The objective. Budget spent on engagement rather than messages, so the platform optimises for people who react and never book.
The destination. Traffic pointed at a homepage instead of a page about the specific procedure being advertised. Any of the three can waste an entire budget while every dashboard metric looks healthy.
Fix the measurement before you fix the spend
You cannot judge a campaign you are not measuring, and most clinics can install adequate measurement in a week: a source question at reception, a tracked link per channel, and a shared sheet with one row per new patient. That is enough to answer all four questions properly.
Do that for sixty days before cancelling anything. Clinics that cancel on instinct usually cut the channel that was working and keep the one that was easiest to see.