Forget lifetime value. The only question that matters: does the spend pay back inside 30 days? Drag the levers.
1 visit
2 visits
3 visits
The big number is your monthly gross profit
What the ad channel throws off in a month — after the therapist's cut and the ads and agency fee. It is not take-home: rent, admin, equipment and the rest still come out of it. A green number is what's left to cover everything else and pay you.
1, 2, 3 visits is the average a patient actually comes back
Not a target — the real average number of times an ad patient comes in. This is the number that runs the whole thing, and almost no clinic measures it. If you don't know your real average, you're flying blind and the agency's "ROAS" is a fairy tale. Track it every week, for ad patients specifically — they behave differently to your regulars.
Break even is the number you have to beat
Land under it and you're paying to lose money. A one-and-done patient is always a loss once the therapist is paid — the second visit is where the profit starts.
Two honesty checks: cost per booking isn't cost per patient (no-shows push your real number up), and visits only count inside 30 days — so treat this as the floor, not lifetime value.
The ad doesn't make you money. The second visit does. — Culture of One