Most full-arch marketing reports stop at the booked consult. That's where the agency's part usually ends, so that's where the counting ends. The money is in the four stages after it, and each one leaks for a different reason.

This is about those four stages: booked, attended, accepted, started. If you count them separately, the leak usually shows itself. If you count them together as "consults", it stays hidden behind a number that looks fine.

The seven stages, and where most reports stop

I measure every engagement in the same seven stages, published on /how-we-measure: seen, inquiry, first reply, booked consult, attended consult, accepted treatment, started case.

Most reports cover the first two. Better ones get to the fourth. Very few go past it, because past it the numbers come from the practice's own records, and nobody has asked for them.

That's a problem for a full-arch practice in particular. The case is large, the decision is slow, and a lot happens between "booked" and "started". A report that ends at booked consults can look healthy for months while the surgical day stays half empty.

The earlier stages matter too. I covered the gap between inquiry and first reply in the full-arch response gap. This post starts where that one ends: a consult is on the calendar.

Booked is not attended

A booked consult is a date and a time. It isn't a patient in the chair.

Full-arch consults get missed for ordinary reasons. The appointment was booked two weeks out and the patient's nerve went. Something came up at work. Nobody confirmed it, so it slipped their mind. With a decision this size and this personal, a gap of two weeks is plenty of time to talk yourself out of it.

What helps is unglamorous, and it has to run every time:

  • Reminders, 24 hours, 2 hours and 15 minutes before the consult.
  • No-show recovery, so a missed consult gets a same-day reach-out instead of a note in the chart.
  • Cancellation backfill, so the open slot goes to the next person waiting.

Count booked and attended as separate numbers. If they're far apart, the fix is in the follow-up, not in the ads.

Attended is not accepted

The patient came in. They saw the scan and heard the plan. Then they said they'd think about it.

This is the stage I'm most careful about, because it isn't mine. The consult, the treatment presentation and the conversation about the plan belong to the doctor and the treatment coordinator. They decide more cases than the ads do. I don't sit in your consult room and I don't pretend to know your patients better than you do.

What I can do is make the stage visible. Count attended consults and accepted treatment plans separately, by service. If attended is steady and acceptance drops, the problem is at stage six, and it's usually not a marketing problem. I'll say that out loud rather than run more ads at it.

There's one part of acceptance that marketing does touch: who walks in. Ads that send back every form fill teach the platform to find more form-fillers, so the consult room fills with people who were never close to a decision. Ads that learn from started cases tend to send people who already know roughly what they want. That shows up at stage six even though the work happened at stage one.

Accepted is not started

A patient who says yes hasn't started yet. For full-arch, the gap between accepted and started is usually financing.

That's why the definition I'm paid on is specific. A paying patient is new to the practice or unseen for eighteen months, came through the work, attended a consultation, accepted treatment on a named service, and made a payment or signed financing. A signed financing agreement counts. A verbal yes doesn't.

Count accepted and started separately too. A full-arch case can take weeks to clear financing after the patient agrees. Some of this month's accepted plans become next month's started cases. If you count them as started on the day of the yes, your numbers look better than your bank account, and the whole point of counting is lost.

The number to work out this week

You don't need me for this. You need last quarter's records.

Count the full-arch consults you actually held, not booked. Count the full-arch cases that actually started. Divide the first by the second. That's how many held consults it takes you to start one case.

I won't give you an industry average to compare it with. I don't trust one, and it wouldn't tell you anything about your practice, your case mix or your coordinator. The useful comparison is your own number next quarter. It's also the second number in the arithmetic in what a full-arch case costs to acquire, and once you have it the rest of that sum gets much easier.

What this means for how I'm paid

I'm measured on scheduled production. Not leads. Not phone calls. Not booked consults.

That's why I count all seven stages every week and why the last two come from your records, not mine. If a case can't be tied to the work, it doesn't count toward my number, even when it probably came from it. That undercounts, and it's meant to.

It's also why the full-arch program is built around a started-case number: fifteen paying full-arch patients in ninety days. If you miss it, you get the entire fee back and I keep working at no fee until you have fifteen, while the agreed ad budget is funded. A promise made on booked consults would be easier to keep. It just wouldn't be worth anything to you.

Full-arch case acceptance questions

Does a financed full-arch case count as a started case?

Yes, once the financing is signed. A paying patient is someone who accepted treatment on a named service and made a payment or signed financing. A verbal yes or an application that hasn't gone through doesn't count yet.

What's a good consult-to-start ratio for full-arch?

Yours from last quarter is the only useful benchmark. Count held full-arch consults, count started cases, and divide. I don't quote industry averages, because they don't account for your market, your case mix or how your consults are run.

Do you train my treatment coordinator?

No. The consult and the treatment presentation stay with the practice. What I do is count attended consults, accepted plans and started cases separately, so if acceptance is where cases are being lost, you can see it and decide what to do about it.

Why do full-arch patients book and then not show?

Usually for ordinary reasons: the consult was booked too far out, nobody confirmed it, or the size of the decision caught up with them. Reminders before the appointment and a same-day follow-up after a miss recover more of these than another round of ads.