How to choose a med spa marketing agency: the 7-line scorecard, 15 interview questions, red flags and the contract terms that protect you

By Benjamin Chua·Published October 19, 2026·19 min read

A surgeon who needs a machined implant part doesn't pick the machinist with the nicest website. She hands over a drawing with tolerances in microns and asks to see sample parts cut to that spec. If the shop can't read the blueprint or measure its own work, it doesn't get near the lathe. Hiring a marketing agency for your clinic is the same job. Your budget and your consult target are the blueprint. The agency's past work is the sample part. Most owners skip both and hire the best presenter in the room.

This guide is the blueprint. It gives you a weighted scorecard, 15 interview questions with the answers you want to hear and the ones that should end the meeting, a script for calling their clients, the contract terms that keep your accounts and your footage in your name, and a 90-day review that tells you whether to keep them. We're an agency, so read this knowing that. Score us with exactly the same rubric and the same questions, and if someone else scores higher, hire them.

How much should you budget before you talk to anyone?

Write the number down before the first call, or the first call will write it for you. Start from three inputs: how many new patients a month you want from the agency, what a new patient is worth to you in their first 90 days, and the return you want on the whole marketing spend. A working rule from the Acquisition.com advisor material is to aim for 3x to 5x return over six to twelve months, counting both the agency fee and the ad spend. Pick 3x as a conservative starting point.

1. 1

   Set your inputs

   G is your monthly new-patient goal from the agency. R is your average revenue per new patient in their first 90 days (pull it from your booking software, don't guess). M is the return multiple you want, 3 as a working rule.

2. 2

   Run the formula

   Maximum monthly marketing budget, fee plus ad spend, equals (G times R) divided by M.

3. 3

   Worked example

   You want 15 new patients a month. A new patient is worth about $1,200 in the first 90 days. Target return is 3x. Budget ceiling is (15 times 1,200) divided by 3, which is $6,000 a month for fee and ad spend combined. Every number here is illustrative. Run yours.

That ceiling is what you take into the meetings. If an agency's fee alone eats most of it, they need to show how the remaining ad spend reaches your goal, or the maths doesn't close. For how the budget sits against the rest of your marketing, including content and local search, the med spa marketing budget guide has the percent-of-revenue working rules and worked examples at each revenue level.

How many agencies should you shortlist?

Five to seven. Hormozi's advice on hiring agencies is to talk to several before you decide, because you only learn what good looks like by comparison (Hormozi, $100M Leads, p. 211). Owners who interview one or two and conclude nobody good exists have usually met the wrong two. To get onto your shortlist at all, an agency should clear four gates:

• At least three current or recent med spa or aesthetic clients willing to take your call.
• Examples of ads and funnels for injectables, laser, skin or surgery that stayed within platform policy. Ask to see them, not hear about them.
• The ability to explain the results of three or more similar clinics in numbers: leads, consults, patients, revenue.
• Agreement on the first call that you will own the ad accounts, the data and the content. If this needs a follow-up conversation, that is your answer.

The 7-line weighted scorecard

Score each agency from 1 to 5 on seven criteria, multiply by the weight, add the seven results. The maximum is 5.0. A working rule: anything under 3.5 is a no, even if it is the highest in the room. If every agency is under 3.5, keep looking (Hormozi, $100M Leads, p. 209). The weights push the two things that predict results, their record in your category and their grip on your economics, to 40 percent of the score between them.

Hormozi frames the whole decision through the value equation: does the agency raise the odds of the outcome you want, and does it cut the time and effort you personally have to put in (Hormozi, $100M Offers, p. 59)? Rows 1 and 2 test the odds. Rows 4 and 6 test the effort. The rubric is just the value equation written down so you can't talk yourself out of it after a good lunch.

The 15 interview questions, with the good answer and the bad one

Ask all 15 on a video call or in person. Score each answer 1 to 5 and feed it into the matching rubric row. The questions come from the Acquisition.com advisor material and are worded for a clinic owner. Say them as written; the specific wording is what makes vague answers obvious.

Question 15 is the one most owners never ask and the one that separates agencies that have scaled a clinic from agencies that have only sold to one. An agency that has done it knows the first thing to break is your injector's calendar, then your front desk, then your show rate. One that hasn't will promise infinite scale, and you'll find out in month three what that costs.

What are the red flags when hiring an aesthetic clinic marketing agency?

Some answers aren't a low score. They're a reason to stop. Any one of these ends the process for that agency, whatever the rest of the rubric says.

• No med spa or aesthetic references who will take your call.
• Dismisses compliance questions, or treats HIPAA, your state board and platform policy as someone else's problem.
• Refuses, or hedges on, your ownership of ad accounts, pixels, pages and raw footage.
• Promises specific revenue or guaranteed results before asking about your average ticket, your capacity or your front desk.
• Avoids specific numbers when asked about past clients.
• Pushes a long contract before walking through your economics.
• Suggests buying reviews, incentivising reviews, filtering who you ask for reviews, or running testimonials and influencer posts without a plain disclosure. The FTC's endorsement guides say a material connection "must be disclosed clearly and conspicuously" and that advertisers are liable for misleading endorsements (16 CFR 255.5 and 255.1, read 2026-10-18), and the FTC's 2024 consumer review rule covers fake and bought reviews and hidden negative ones (16 CFR 465). Google's Business Profile rules say incentivised reviews are not allowed on Maps. An agency that proposes any of this is proposing to put your licence and your listing at risk.

How do you reference-check a marketing agency?

Call or video-call two or three current clients. Not the ones in the case study PDF, the ones you choose from the list they gave you at the shortlist stage. Ten minutes each. Use this script and don't improvise; the questions are ordered so the useful answers come after the polite ones.

“Hi, I'm considering working with [Agency]. I'm not asking for confidential numbers, just your honest experience. How long have you been with them? What were your numbers like before and after, roughly, in leads, consults and revenue? What do they do best? What frustrates you? If you had to leave them tomorrow, why would it be? Would you hire them again knowing what you know now?”

Score what you hear into rows 1 and 6 of the rubric. The fifth question does most of the work. Every client has a reason they'd leave, and a reference who can't think of one hasn't been a client long enough to count.

What should the contract say?

Think about who holds the master key to your building. A high-rise has one key pattern that opens every door that matters, and nobody hands that file to a stranger without a contract, a log of who has copies and a spare in the safe. Your ad accounts, your pixel and your tracking are that key. The contract is where you decide who holds it. Have a healthcare attorney read the whole thing; advertising rules, board policies and state law all vary. These are the clauses to ask for.

The ownership clauses matter more than the price. An agency that owns your accounts owns your pixel history, your audiences and your ad learning. When you leave, you start from zero. If the account ever gets restricted, you can't even appeal it yourself. The disabled ad account guide explains what that recovery looks like, and why you want to be the admin when it happens.

Which pricing model should you choose?

Four structures cover almost every proposal you'll receive. The dollar figures below are illustrative examples of how each model is built, not quotes and not averages, and they are not our pricing. What matters is the incentive each model creates.

A working rule from the same source: be wary of very cheap retainers and of commission-only deals. Good agencies tend to look expensive on the fee line and cheap on the cost-per-patient line (Hormozi, $100M Leads, p. 210). Compare them on the rubric, then on cost per treated patient, and only then on the fee.

The 90-day keep-or-replace review

Decide before you sign what good looks like at 30, 60 and 90 days, and write it into the contract off-ramp. The Acquisition.com retention playbook calls these activation points: the early behaviours that predict whether a relationship is worth keeping (Acquisition.com Retention playbook, p. 17 and p. 35). Track the agency's campaigns only, weekly, in nine columns: leads, cost per lead, consults booked, show rate, treatments started, revenue from agency-sourced patients, response time to new leads in minutes, new creatives launched, and whether the report arrived on time.

Hold the day-90 meeting formally, with the scorecard on the screen. Owners who skip it drift into month eight still hoping. The thresholds above (60 percent show rate, 20 to 30 percent of plan, two of three goals) are working rules; the point is that you agreed them in writing on day one so the conversation is about numbers, not feelings.

The five most expensive mistakes clinic owners make

1. 1

   Picking on charisma instead of maths

   The slickest presenter with the flashiest reel wins the room. Make every agency walk through your economics on the first call and write down their assumptions. If they can't do the arithmetic, they can't buy media.

2. 2

   Signing long contracts with no exit triggers

   Twelve months, no review, no off-ramp. Standardise on a three-month pilot, the 90-day scorecard, and 30-day notice after that.

3. 3

   Letting the agency own your assets

   Ads, pages and pixels all inside their accounts. Put ownership in the contract and verify the account structure yourself before the first dollar moves.

4. 4

   Expecting the agency to fix a broken front desk

   Poor show rates, slow follow-up and weak closes get blamed on the ads. Install the deposit, the confirmation texts and a 7-minute callback before or alongside hiring; the no-show fix has the scripts. Agencies amplify a system. They don't replace one.

5. 5

   Not benchmarking enough agencies

   Two meetings, then "nobody good exists." Commit to five, score every one, and let the rubric choose (Hormozi, $100M Leads, p. 211).

What if you already have an agency?

Run the 90-day scorecard backwards. Pull the last three months of leads, consults, shows, treatments started, revenue and response times from their campaigns. If the numbers are improving and the communication is steady, they may be better than they feel. If not, start the shortlist now and run both in parallel; a working rule is never to switch off a profitable channel until the replacement is performing at least as well. Lead droughts are expensive, and a quiet week at the desk tends to get blamed on the new agency before it has launched anything.

Whichever way you go, the agency should not be your only source of patients. Content your injector films once and posts for a year keeps working whoever is running the ads. The free 12-month content plan at /free-plan gives you that calendar without an agency attached.

Where this comes from

• The budget formula, shortlist gates, seven-row rubric and weights, 15 questions with good and bad answers, contract clauses, pricing models, reference-check script and 90-day review are adapted from the Acquisition.com advisor material on choosing an agency, with the book and playbook references it gave: $100M Leads pages 209 to 211 (picking an agency, talking to several, good agencies look expensive), $100M Offers page 59 (value equation) and page 135 (performance-linked compensation), the Acquisition.com pricing playbook page 24 and $100M Money Models page 150 (separate one-time from recurring fees), and the Acquisition.com retention playbook pages 17 and 35 (activation points).
• FTC endorsement guides, 16 CFR Part 255 (eCFR, current as of 2026-10-01, read 2026-10-18): material connections must be disclosed clearly and conspicuously; advertisers are liable for misleading endorsements. FTC consumer reviews and testimonials rule, 16 CFR Part 465 (eCFR, same read date): fake reviews, bought reviews and suppressed negative reviews. FTC Disclosures 101 for Social Media Influencers (ftc.gov, read 2026-10-18).
• HIPAA marketing authorisation, 45 CFR 164.508(a)(3) (eCFR, current as of 2026-10-01, read 2026-10-18). Whether a given med spa is a covered entity, and whether an agency needs a business associate agreement, is a question for your counsel; the HHS marketing guidance page did not load for us.
• Google Business Profile prohibited and restricted content (support.google.com/business/answer/7400114, read 2026-10-18): incentivised or biased reviews not allowed, and no discouraging negative reviews or selectively soliciting positive ones.
• Working rules, not published standards: the 3x to 5x return target, the 3.5 rubric cutoff, five to seven agencies, four to eight creatives a month, eight to twelve accounts per manager, the three-month term and 30-day notice, the 60 percent show rate and 20 to 30 percent cost-per-lead tolerance, and the two-of-three day-90 test. Adjust them to your clinic.
• Every dollar figure ($1,200 per patient, $6,000 budget, the Dallas example in question 1, and the pricing model examples) is illustrative. None is a Med Spa Launch price.
• Nothing here is legal advice. Have a healthcare attorney review any agency contract before you sign.

Questions owners ask

Written by Benjamin Chua

Founder of Trueframe and Med Spa Launch. Nine years building video systems for founders and clinics, including a Melbourne plastic surgeon whose account went from 12,043 to 36,236 followers in ten weeks.