How to choose a marketing agency for chiropractors, physios and osteopaths: judge it route by route

We produce articles and AI-search work for MyChiro Clinic, one chiropractic clinic, so we have a commercial interest here, and that work does not establish experience with physiotherapy or osteopathy practices. The question it puts to any agency is a routing one: for each way a patient reaches a clinic, which profession's advertising list does the page follow, and who at the clinic signs it off?

Search and maps: the first stop, and the first place to break a rule

Search is the largest first step we can source. A YouGov survey of 2,100 UK adults, run on 13 and 14 July 2026, found that 26 percent turn to a search engine first for health information. It puts health websites at 23 percent and healthcare professionals at 17 percent. That question was about health information in general, not about picking a clinic. For chiropractors, the clinic's own site carries weight once a patient is choosing. Research from the General Chiropractic Council (GCC), published on 5 September 2023, found that patients lose confidence in a practice whose website lacks professionalism. The same research found that patients expect to see the I'm Registered mark and are reassured by transparent fees and an online booking system.

The first trap is the badge. The GCC says its mark is exclusive to registrants. It adds that an unregistered person who uses it commits a criminal act. It also tells registrants not to use its corporate logo, because that may suggest it endorses the practice. The Health and Care Professions Council (HCPC) sets a different condition for physiotherapists. Its registered logo may only be used with the name of an individual registrant, not a company, firm or other business, and not in a trading name. Our reading is that a clinic template with a badge in the header can break either rule. Find out where each badge will appear and which named registrant it belongs to.

The second trap is a platform that allows what a regulator may not. Google's guidelines say practitioner profiles may include a title such as Dr. CAP's osteopathy advice says osteopaths without a general medical qualification should avoid Dr, because it is likely to be read as claiming one. Ask whose rule the agency follows on your listing, and who checks it.

The third trap is the conditions list. The ASA and CAP publish an accepted list for chiropractors that includes general, acute and chronic backache not arising from injury or accident. Osteopaths get a separate list that includes arthritic pain and fibromyalgia. A condition page copied from one profession's clinic to another carries the wrong list with it. Ask which profession's list each page follows. In the US, state boards can add advertising rules of their own. In Texas, a chiropractic licensee cannot call a service free unless the advertising states every component service included. Ask which board's rules the agency has read for the state you practise in, and which of them changed a line of copy.

Reviews are the fourth trap, because they sit on the map. Google's contribution policy rules out payment, discounts, free goods or services offered in exchange for posting any review, so a free first session for a five-star review fails before any law is reached. The Competition and Markets Authority's 2025 guidance also treats a free or discounted product given for a five-star review that does not reflect genuine experience as commissioning a fake review. Ask to see the agency's review request in writing.

AI answers and articles: what no agency should promise

AI tools are a smaller first stop, but a real one. In the same YouGov survey, 8 percent of UK adults said they first turn to standalone AI tools for health information. Among those who had used AI for health in the previous three months, researching a condition and understanding symptoms were the most common uses, at 16 percent each. In the US, a KFF poll published on 25 March 2026 found that 32 percent of adults had used AI chatbots for health information in the past year.

Google says that even a page meeting all its requirements has no guarantee that it will be indexed or served. Its guidance also says no new machine-readable files or special markup are required for its AI features. It also says there is no special schema.org structured data you need to add. That covers Google only. As we read that guidance, a fee for special files, or a promised citation, needs a better explanation than the agency's word. For the mechanics, see our explainer on answer engine optimisation.

The trap in articles is that a quotable sentence can travel alone. Write every sentence so that it is safe if read without the page around it. For chiropractic, the GCC's subluxation guidance, in force since 1 January 2026, still describes the vertebral subluxation complex as a theoretical model. It adds that no clinical research evidence supports claims that it causes disease. Ask to see how a proposed article treats it before anything is published. The same guidance restates the Code of Professional Practice: what a chiropractor tells people about their services has to be factual, verifiable and not misleading, and delegating that does not move the accountability. Ask who signs off each article, by name, and which register that person sits on.

In the US, a named patient story also brings in HIPAA, under which a covered entity generally needs a valid authorisation before it uses a patient's health information, so ask what consent stands behind any story the agency proposes and whether your clinic is a covered entity.

Referrers and insurers: listings you cannot buy

Many patients never start with a search. The GCC's 2023 research found that personal recommendations are important to patients when choosing a chiropractor. An earlier GCC study, published in January 2013, found that most of the patients it interviewed chose their chiropractor because the clinic was local or recommended by family, friends or their GP. In England, the NHS says many areas let patients reach community musculoskeletal physiotherapy without seeing a GP first. For a private physiotherapy clinic, that is a free alternative on the same patient's doorstep.

Insurers add a route of their own. One product, AXA Health's small-business Therapies option, covers up to 10 sessions a year of treatment from a physiotherapist, osteopath, chiropractor or acupuncturist. It needs no GP referral if its muscles, bones and joints service refers the patient for physiotherapy or osteopathy. That is one insurer and one product, not the market.

At Bupa, at least, network entry runs on credentials, not copy. Bupa says its osteopaths and chiropractors must hold accreditation with the GOsC or the GCC and have a clean record with the regulator. For physiotherapy it recognises the whole practice. The practice needs a named lead clinician registered with the Chartered Society of Physiotherapy and the HCPC, with at least five years' post qualification experience in full time practice. The September 2018 edition of Bupa's terms for recognised osteopaths and chiropractors says what it may publish on its websites. That is your name and qualifications, the type of treatment you deliver, the facilities where you practise, and your professional contact details. So an agency cannot write or buy your place in these directories: the entry follows your registration and your application. Ask whether the agency claims otherwise. Ask too for a report that keeps patients who pay for themselves apart from those an insurer sent or the NHS pointed your way, so you can see which route it is working.

In the US, two payer rules change what a booking page can promise. Medicare Part B pays a chiropractor only for spinal manipulation that corrects a subluxation. It also does not cover other services or tests a chiropractor orders, including X-rays. For physical therapy, the American Physical Therapy Association (APTA) counts, at 1 July 2025, provisional or unrestricted direct access to evaluation and treatment by a physical therapist in every state, the District of Columbia and the US Virgin Islands. Licensure itself is managed by individual state regulatory boards, so check your own board. Yet Medicare says your doctor or other health care provider must certify that you need physical therapy. A booking page saying "no referral needed" can therefore mislead a Medicare patient. Ask how the agency words referral and Medicare cover. Ask how it describes a care plan to a Medicare patient.

Accounts, data and creative: who owns what

Whichever route you buy, the clinic should own it. Google's help says an owner has full control of a Business Profile and can add or remove users or delete it. A manager cannot add or remove users or remove the profile. Make the clinic the owner and add the agency as a manager. Ask for the same arrangement on ad accounts, analytics and the domain name, so ending the contract never means losing them. Ask who owns the articles, photographs and video, and have the answer written into the contract rather than the proposal. Ask for a copy of your data and creative on exit, in formats you can open.

When something is not working

Agree at the outset what "not working" means, in numbers you can read from your own booking system. Enquiries or booked assessments below an agreed level at two reviews running is one example. Agree who raises it, how many working days the agency has to bring a plan, and what happens next, including how you leave. A plan with no date is not a plan.

One failure needs its own plan in a regulated health profession: a claim that is questioned. The CAP Code makes the marketer primarily responsible for keeping to it, which here means the clinic, while agencies that help prepare the ads also take on a duty to abide by it, so agree in writing who takes a page down, and how quickly, if the ASA or your regulator raises it.

When to wait, or hire someone other than an agency

An agency is not always the right first spend. Suppose your own records show that patients sent by a GP, an insurer or a friend outnumber those who search. Then search work will move less of your diary, and your time may do more. Check that your register entry and profile details match. Ask each insurer's provider team what recognition needs. A freelance clinician-writer, or a one-off site build, can beat a monthly retainer when what you need is one set of accurate pages. Hiring in-house makes sense when someone already answers the phone and can keep the Business Profile current. And if you cannot yet say which patients you want more of, waiting costs less than briefing badly.

Your own route mix is what should change the choice. If most new patients find you by search, weigh the search and maps checks most heavily and pick the agency that answers them best. If an insurer or a GP sends most of them, an agency's search work matters less than keeping your register entry, insurer listings and website consistent, which is a smaller and cheaper brief. If you are a physiotherapy clinic competing with a free NHS route nearby, the useful agency is the one that can show which patients chose to pay, and why, rather than one that promises more enquiries. How we work with clinics on these routes is on our page for chiropractors, physios and osteopaths.

Route by route, on one page

Take this into every meeting and ask for a written answer to each row.

For a conversation about your clinic's patient routes, tell us about your business.