We are an agency, so read this with that in mind. It is still the list we would want a clinic to run us through, and a few of these we would fail — which is rather the point of writing them down.

1. Who else in my area do you work with?

The answer you want is a name or a clear “nobody”. An agency working with two clinics in one metro is optimising the same keywords for both, and one of you is paying to lose. If the answer is vague, ask it again more directly.

Walk if: they say it “isn’t a conflict because the strategies are different.”

2. Who owns the accounts?

Google Ads, Analytics, Search Console, the site, the content, the call tracking numbers. All of it should be in your name with the agency granted access, not the other way round. This is the single most common way clinics get stuck.

Walk if: the accounts are theirs and you get “access”. You are renting your own data, and leaving means starting from zero.

3. What happens to my rankings when I stop paying you?

An honest answer is nuanced: content and technical fixes largely persist, ads stop immediately, and link authority decays slowly. An agency that claims everything collapses is describing a hostage situation, not a service.

4. Show me a page you wrote for another fertility client.

Not a report. Not a dashboard screenshot. An actual page. You are buying writing and judgment; look at the writing.

5. Who writes the medical content, and who reviews it?

This is the one that matters most in this category, and the one most agencies answer badly. Content about IVF success rates, medication protocols or embryo grading is health content. Google’s guidance on pages that can affect health, finances or safety is explicit that it expects demonstrable expertise. In practice: a named reviewer with real credentials, visible on the page.

Walk if: the answer is “our writers are very experienced” with no clinician anywhere in the process.

Our own position, since it would be dishonest to ask this and dodge it: we write and fact-check against published sources, flag every medical claim in the draft, and one of your own physicians reviews those claims and signs the page off, named, with the date. We do not have a retained medical reviewer of our own. If that matters to you, and it reasonably might, ask us before you sign, not after.

6. What are you going to fix before you send traffic?

If the answer is “we’ll start the campaign next week”, the site is not being looked at. Paid clicks landing on a page that cannot convert them is the most expensive mistake in this category, because you pay full price for every visitor the page then loses.

7. How will we know a consultation came from your work?

You want to hear about call tracking, UTM parameters, form source capture, and something that ties a booked consultation back to its origin. “We’ll send you a monthly report” is not an answer — the question is what the report is built from.

8. What does month three look like if this is going badly?

A good agency has thought about this and will tell you what the early warning signs are. An agency that has never considered failure has not run many campaigns.

9. What is the notice period?

Month to month with thirty days notice is a fair deal for both sides. Twelve-month lock-ins exist to protect the agency from its own results. If the work is earning its cost, you will not want to leave; if it is not, you should be able to.

10. What have you got wrong before?

The most useful question on the list, and the one with the highest chance of a rehearsed non-answer. Anyone who has done this work for real has a story about a campaign that did not work and what they changed. “Nothing comes to mind” means either very little experience or very little honesty.

11. Who is actually doing the work?

Common pattern: you meet a senior person during the sale and never speak to them again. Ask who writes, who builds, who is in the account weekly, and whether any of it is subcontracted. There is nothing wrong with a small team — there is something wrong with not being told.

12. Will you sign a business associate agreement?

Fertility marketing touches health information sooner than most clinics realise: an enquiry form that asks about treatment, a call recording, a CRM full of people who contacted a fertility clinic. Under HIPAA, any vendor that handles that information on your behalf needs a business associate agreement with you, and so do the tools they use to handle it. Ask which tools will touch patient information, and whether each one is covered.

Ask about tracking too. Advertising pixels on pages where patients enter details have been the subject of federal guidance and lawsuits in recent years. An agency should be able to tell you exactly what fires on your treatment and contact pages, and why.

Walk if: the answer is “we don’t deal with patient data”, from an agency that is about to set up your forms, CRM and call tracking.

13. Can I see the numbers myself, any time?

Monthly PDF reports are fine, but you should not need the agency to know how your marketing is doing. Ask for your own logins to Google Search Console, Google Analytics, the ads account and the call tracking platform, and for a live dashboard showing enquiries and booked consultations by source. If the reporting dashboard only exists inside the agency, so does your understanding of your own marketing.

The answers that should worry you

  • A guaranteed position. Nobody controls Google’s index. A guarantee is either a misunderstanding or a lie, and both are disqualifying.
  • A number of leads promised before they have seen your site. They do not know your conversion rate, your market, or your current baseline. The number is invented.
  • Named clinics as clients with no way to check. Ask if you can call one.
  • Reluctance to explain something. If a question about your own marketing gets answered with jargon, that is a choice. You are the client; you get to understand what you are buying.

What we would fail on

For symmetry, since we would be asked these too. We are new, so question 4 has a thin answer and question 10 has to draw on adjacent work rather than a long fertility client list. Question 5 we answer honestly above, and it is the gap we are working hardest to close.

If you want to run this list at us, the free website plan is a reasonable place to start — you get a written assessment of your own site before any money changes hands, which is also the fastest way to find out whether the thinking is any good.