Three years of your own records, read in full: 9 programs, 36,300 visits, 9,860 phone calls, 484 website and ad inquiries, and every payment since October 2023.
Two labels run through this document. From your data means the figure was counted from your own records. Our estimate means it is a projection, and the assumption behind it is stated beside it so you can disagree with it.
Nothing in this document identifies a patient. We counted records. We read whether a chart note was signed and when. We did not read what any note says.
01The short version
Wellness Practice is a sound practice that is losing patients and visits in three places it cannot currently see.
What is working
- Revenue has grown each year, to $1,150,000 in the last twelve months. From your data
- Patients send you patients. 192 of 600 new patients came from another patient, and 79% of those came back a second time. From your data
- When a new patient leaves the first visit with the next one booked, 90% return. From your data
Where you are losing money
- People who try to become patients and never hear back, and cancelled slots nobody is offered. 229 new inquiries got no reply. 651 slots cancelled inside 24 hours stayed empty, while 64 people sat on a waitlist. From your data
- New patients who come once. 186 of 600 new patients never came a second time. 228 left the first visit with nothing booked. 412 patients have gone quiet in the last 90 to 180 days and nobody has contacted them. From your data
- Visits delivered and not billed. 116 visits in the last twelve months have no charge and no note explaining why. 68 rejected insurance claims were never sent again. From your data
The three things to fix, in order
- Answer every new patient inquiry, and offer every cancelled slot to the people waiting. What it is costing you: about $26,100 a year. Our estimate
- Book the next visit before the patient leaves, and contact patients as they go quiet. About $25,800 a year. Our estimate
- Bill every visit, and fix the record problems. About $10,100 a year, plus up to $6,200 once. Our estimate
The one number to improve first: the share of late cancelled slots that are refilled. Today it is 18%.
These figures are what each problem is costing you. They are not a promise of what will be recovered.
02What you asked for
On our first call, you were asked: if you could wave a wand and have one thing in your business handled automatically, perfectly, every time, what would it be?
Your answer, word for word:
"When a patient cancels, that opening gets offered to the people who are waiting for one, and it is filled before the day comes. Without my front desk working down a paper list and leaving six voicemails."
The records agree with you. 794 appointments were cancelled with less than 24 hours of notice, and 143 of those slots were refilled. Your two fullest practitioners had 318 of the slots that stayed empty, and they are the two practitioners people are waiting for. Fix 1 is built around your answer.
03What we looked at
| Software | What was read | Period |
|---|---|---|
| Jane | 6,158 patient records, 42,900 appointments, 36,300 visits, shifts, packages, charges, insurance claims, and whether each chart note was signed | October 2023 to September 2026 |
| QuickBooks Online | Every deposit, bill and the general ledger | October 2023 to September 2026 |
| Gusto | Hours and pay for all 7 people | October 2023 to September 2026 |
| Quo phone system | 9,860 inbound calls and 14,300 texts | October 2025 to September 2026 |
| Google Business Profile | Views, calls, direction requests, reviews | April 2025 to September 2026 |
| Meta Ads | Spend, audiences and 198 lead forms | October 2025 to September 2026 |
| Mailchimp | 3,940 subscribers and 2 mailings | October 2025 to September 2026 |
| Website booking page and contact form | 286 inquiries and the replies to them | October 2025 to September 2026 |
| The front desk's shared spreadsheet | The waitlist, the package tracker and the insurance follow up log | Current version |
How new patients were counted. 612 new patients came in the last twelve months. A patient who first came in September has not had time to return. So parts 6 and 7 follow the 600 patients who first came between 1 July 2025 and 30 June 2026. Each of them has had at least 90 days to come back.
What was missing. Phone history before October 2025 is not held. Nobody records why a patient stops coming. 58 of the 600 new patients have no source recorded. A person who sees an ad and then phones cannot be tied to that ad.
Confidence. High on visits, the schedule and who returned. High on money in total. Medium on marketing, because of the tracking gaps. The value of an unanswered inquiry is an estimate and is labeled as one.
04The shape of your business
Five kinds of income make up the year. From your data
| Income | Revenue, last 12 months | Share |
|---|---|---|
| Acupuncture follow up visits | $483,000 | |
| Chiropractic follow up visits | $437,000 | |
| First visits and exams | $92,000 | |
| Added services during a visit | $69,000 | |
| Herbs, supplements and products | $69,000 | |
| Total | $1,150,000 |
Most of it is paid by patients directly. From your data
| Who paid | Revenue | Share | Visits | Paid per visit |
|---|---|---|---|---|
| Patients directly | $897,000 | 8,886 | $93 | |
| Insurance | $253,000 | 3,514 | $72 |
The direct figure includes the $69,000 in products. The paid per visit column leaves products out. Across all 12,400 visits, the average visit brings in $87.
Growth is slowing. Revenue rose 9.1% two years ago and 3.2% in the last twelve months. From your data
One patient in ten makes a third of your visits. 1,640 patients were seen in the last twelve months. 164 of them made 4,216 visits, or 34% of the year. From your data These are your long term regular patients, and they are the reason the practice is stable.
One insurer is 61% of your insurance income. It paid $154,000, which is 13.4% of all revenue. Its fee schedule was last updated in 2022. From your data
The year has a pattern. January is your strongest month, with 9.8% of the year's visits. December is the weakest, with 6.4%. From your data
This is why everything below comes in this order. The practice has room for more patients, but only with three of its five practitioners. The first job is to answer and keep the people who already found you.
05Where the money comes from and where it goes
You kept 11 cents of every dollar. Operating profit was $127,000 on $1,150,000, after your own pay as a practitioner. From your data
| Where each dollar went | Share of revenue |
|---|---|
| Practitioner pay | 44% |
| Front desk and office pay | 9% |
| Rent and utilities | 11% |
| Supplies, herbs and products | 7% |
| Marketing | 4% |
| Software, insurance, card fees and other overhead | 14% |
| Operating profit | 11% |
Visits delivered with no charge: 187. We matched every visit marked as arrived in Jane against every charge. 187 visits have none. 71 carry a note saying the visit was free. The other 116 have no explanation. At your average visit of $87, those 116 are worth about $10,100. From your data, valued at your average visit.
You hold $74,600 for visits you have not delivered yet. Patients have 1,148 prepaid visits left on packages. 392 of those visits, worth $25,500, belong to 87 patients who have not been seen in 180 days or more. From your data QuickBooks records a package as income on the day it is sold, so your books do not show this as money owed in visits. Please raise this with your accountant.
Jane and the spreadsheet disagree on 41 package balances. The front desk tracks packages in both places. For 41 patients the two show a different number of visits left. From your data Somebody is being told the wrong balance.
Your prices last changed in January 2024. Since then, practitioner pay per hour has risen 9%. From your data A $5 increase on your 8,886 direct pay visits would be $44,430 a year. Our estimate, assuming no patient leaves over it. This is your decision, and it is not counted in the amounts you are losing.
$96,400 is owed to you. From your data
| Who owes it | Total | More than 90 days old |
|---|---|---|
| Insurers | $61,300 | $14,200 |
| Patients | $35,100 | $18,600 |
| Total | $96,400 | $32,800 |
Insurers pay a median of 34 days after the visit. A claim is sent a median of 6 days after the visit. 388 patients carry a balance, and 61% of your active patients have no card on file.
68 rejected claims were never sent again. The company that handles your insurance claims returned them, and they sit in Jane with no further action. They were billed at $6,200. Some are now past the insurer's filing deadline. From your data
The late cancellation fee is charged 15% of the time. Your policy sets a $40 fee. There were 1,340 late cancellations and no-shows, and the fee was charged on 201. From your data Whether to charge it is your call. It is not counted in the amounts above.
Software costs $13,920 a year across 11 tools. Two of them do a job Jane already does, at $118 a month. From your data
06Who stays and who drifted
Three new patients in ten come once. From your data
| Of 600 new patients | Patients | Share |
|---|---|---|
| Came for a first visit | 600 | |
| Came a second time | 414 | |
| Came a third time | 330 | |
| Came a fourth time | 282 | |
| Came a sixth time | 222 |
The largest loss is at the first return: 186 patients. Another 84 stop after the second visit and 48 after the third.
The strongest pattern is whether the next visit was booked before the patient left. No other pattern in the records comes close. From your data
| When the patient left the first visit | Patients | Came back | Share |
|---|---|---|---|
| The next visit was already booked | 372 | 335 | |
| Nothing was booked | 228 | 79 |
It depends on who they saw. The share of new patients who leave with a next visit booked runs from 44% to 81% across your five practitioners. From your data The practitioners who walk the patient to the desk are the ones at the top.
What a returning patient is worth. A first visit averages $150. A new patient who comes back spends another $610 over the following twelve months. Across all 600, the average new patient is worth $571 in the first year. From your data
Where every patient record stands today. From your data
| Last visit | Patient records |
|---|---|
| In the last 90 days | 1,012 |
| 90 to 180 days ago | 412 |
| 180 days to two years ago | 1,236 |
| More than two years ago | 2,870 |
| No visit on record | 628 |
| Total | 6,158 |
Nobody contacts a patient who goes quiet. The 412 patients in the 90 to 180 day group have had no call, text or email from the practice since their last visit. Mailchimp has sent two general newsletters in a year. From your data
Patients who return after a gap do stay for a while. In your records, a patient who comes back after 90 days or more makes an average of 4.1 visits in the next twelve months, worth $357. From your data
Regular patients are coming a little less often. The median gap between visits for patients with ten or more visits was 16 days two years ago. It is 19 days now. From your data
Older groups thin out fast. 574 patients first came in the year to September 2024. 132 of them, or 23%, were seen in the last twelve months. From your data
07How new patients find you
600 new patients, by where they came from. From your data
| Source | New patients | Came back a second time | Share |
|---|---|---|---|
| Referred by a patient | 192 | 152 | |
| Google search and your Google profile | 146 | 102 | |
| Insurance directory | 70 | 47 | |
| Meta Ads | 60 | 25 | |
| Referred by a doctor or other provider | 52 | 42 | |
| Walked or drove past | 22 | 14 | |
| No source recorded | 58 | 32 | |
| Total | 600 | 414 |
Meta Ads cost $360 for each new patient, and those patients spent $310 in their first year. You spent $21,600 and gained 60 patients. 25 of them came back. From your data
A third of the ad money was shown too far away. $7,300 of the $21,600, or 34%, reached people more than 15 miles from the clinic. 4 of the 60 Meta patients live that far out. From your data
Ad leads wait 2.4 days for a first contact. Meta lead forms arrive in an email inbox that is checked about twice a week. 47 of 198 leads were never contacted. From your data
New patients are sent to the two practitioners with no room. 348 of the 612 new patients in the last twelve months, or 57%, were booked with practitioners 1 and 2. Their next opening for a new patient is 15 days away. Practitioners 4 and 5 can see a new patient within 2 days. From your data
Your best source costs nothing and has no process. Patient referrals bring the most new patients and nearly the best return rate. Nothing in any program asks for one.
Your Google profile is seen 5,200 times a month. In 18 months it produced 2,610 call clicks, 3,480 website clicks and 1,150 direction requests. From your data The profile is right. Bing shows Saturday hours you no longer keep, and the Yelp page is unclaimed.
What cannot be measured yet. A person who sees an ad and phones the clinic is not tied to that ad. Asking "how did you hear about us" on every first call, and recording the answer in Jane, closes the gap. That is part of Fix 1.
08How fast you answer
Nearly one call in four is missed. 2,268 of 9,860 inbound calls went unanswered. Between 12 and 2, when one person covers the desk, 607 of 1,480 calls were missed, or 41%. From your data
148 callers who were not patients never heard from you. Most missed calls came from patients who reached you later. 412 came from numbers that are not in Jane, and 148 of those were never called or texted back. From your data Not every one was a new patient. Some were suppliers or wrong numbers.
Website inquiries wait 19 hours. That is the median time to a first reply. 34 of 286 inquiries were never answered. From your data
229 inquiries got no reply at all. From your data
| Where the inquiry came from | Received | No reply |
|---|---|---|
| Missed calls from numbers not in Jane | 412 | 148 |
| Website contact form | 286 | 34 |
| Meta lead forms | 198 | 47 |
| Total | 896 | 229 |
What this is worth. Of the 403 website and Meta inquiries that did get a reply, 210 became a first visit, or 52%. The average new patient is worth $571 in the first year. So each answered inquiry is worth about $297. If a quarter of the 229 unanswered inquiries were real prospects, that is 57 people and about $16,900 a year. Our estimate
09What patients say
214 Google reviews, average 4.8. Only 17 arrived in the last twelve months, against 12,400 visits. From your data
31 reviews have no reply, including five of your seven reviews below three stars. A reply from a health practice has to be written so that it does not confirm the reviewer is a patient. We draft them that way for you to approve.
What people praise: being listened to, and getting better. What people complain about: not being able to reach the clinic by phone, and a long wait for a first appointment. Both complaints match the records in parts 7 and 8.
10How your week runs
71% of your open hours were booked. Your practitioners had 8,600 hours open in Jane, and 6,091 were booked. From your data The average hides big differences between practitioners.
| Practitioner | Hours open | Hours booked | Share booked |
|---|---|---|---|
| 1, chiropractic (you) | 1,500 | 1,365 | 91% |
| 2, acupuncture | 1,800 | 1,566 | 87% |
| 3, chiropractic | 1,800 | 1,242 | 69% |
| 4, acupuncture | 1,900 | 1,102 | 58% |
| 5, acupuncture | 1,600 | 816 | 51% |
| All five | 8,600 | 6,091 | 71% |
2,509 open hours were not booked. 2,140 of them sit with practitioners 3, 4 and 5.
Each booked hour brings in $177. Each open hour brings in $126. From your data That gap is the number to watch as the schedule fills.
One booked slot in ten ended empty. From your data
| What happened to 14,620 booked appointments | Appointments | Refilled | Ended empty |
|---|---|---|---|
| Delivered | 12,400 | ||
| Cancelled with more than 24 hours of notice | 880 | 607 | 273 |
| Cancelled with less than 24 hours of notice | 794 | 143 | 651 |
| No-show | 546 | 0 | 546 |
| Total | 14,620 | 750 | 1,470 |
At your average visit, 1,470 empty slots are about $127,900 a year. That is the whole amount lost. It is not the amount that can be won back. Some people will always be ill on the day.
Late cancellations can often be refilled. Of the 794, 468 gave between 4 and 24 hours of notice. 326 gave less than 4 hours. From your data
The waitlist is on a spreadsheet. It holds 64 names. 23 were added more than 60 days ago. Jane has its own wait list, and it holds 7. When a slot opens, your front desk phones down the spreadsheet. From your data 318 of the 651 late cancelled slots that stayed empty were with practitioners 1 and 2. If a third of those were refilled, that is 106 visits and about $9,200 a year. Our estimate
No-shows are less than half as common when the patient gets a text reminder. From your data
| Reminder the patient received | Appointments | No-shows | Share |
|---|---|---|---|
| Text and email | 9,870 | 257 | |
| Email only | 4,750 | 289 |
Patients get email only when Jane holds no mobile number for them or no consent to text.
Patients book 31% of their own appointments online. 4,532 of 14,620. The rest go through the front desk. From your data
Your own hours. You estimated 12 hours a week on office work, 5 of them answering schedule and billing questions from the front desk. Your estimate. Your front desk estimated 9 hours a week on cancellation calls and the waitlist, and 4 on keeping the spreadsheet. Their estimate.
11Your software and your records
The tools are good. Two jobs are being done outside them.
| Tool | What it does for you | Verdict |
|---|---|---|
| Jane | Schedule, charts, packages, charges, claims, online booking, reminders | Keep. Make it the one place your records are kept, including the waitlist and packages. |
| QuickBooks Online | The books | Keep. Ask your accountant how package sales should be recorded. |
| Gusto | Payroll | Keep. |
| Quo | Phones and texts | Keep. Add a text back on missed calls. |
| Google Business Profile | How people find and review you | Keep. Reply to reviews. |
| Meta Ads | Paid new patient leads | Your decision. See below. |
| Mailchimp | Two newsletters a year | Keep for general news only. See below. |
| Website booking page and contact form | Online booking and inquiries | Keep. Send the form to the front desk's phone, not only to email. |
| The shared spreadsheet | Waitlist, package tracker, insurance follow up log | Replace with Jane, one tab at a time. |
| Two overlapping tools | A second reminder service and a second form tool | Cancel. $118 a month. |
Meta Ads: our advice is to pause them. The ads bring patients who cost more than they spend, a third of the money reaches people too far away, and leads wait 2.4 days. Fix the answering first. Then restart within 10 miles and judge again. This is your decision.
Mailchimp and patient information. Mailchimp states that its service is not meant for protected health information. So a message that refers to a person's care, such as "it has been three months since your last visit," should go through Jane or by a text from the clinic's own number, and not through Mailchimp. This is something for you to check with whoever advises you on privacy. It is not legal advice.
Record gaps. 214 patient records are duplicates. 742 have no email address. 318 have no mobile number, so those patients cannot get a text reminder. From your data
Access. 4 people who no longer work for you still have a working login to at least one program. From your data This is something for you to act on this week.
What only one person knows. One front desk person knows how to follow up a rejected claim, and keeps the log of them.
Billing and record items to check
These are items for you and your biller to check. They are not legal or coding advice. We counted records and did not judge any clinical or coding decision.
| Item | Count | Why it is worth a look |
|---|---|---|
| Chart notes unsigned for more than 7 days | 143 | 38 are more than 30 days old. 61 belong to insurance visits that were already billed. |
| Arrived visits with no charge and no explanation | 116 | See part 5. |
| Rejected claims never sent again | 68 | Billed at $6,200. Some are past the filing deadline. |
| One billing code on nearly every insurance visit | 742 of 765 | Practitioner 3's insurance visits carry the same code 97% of the time. The other four practitioners vary. There may be a good reason. |
| Insurance visits dated after the coverage end date on file | 23 | The coverage record may be out of date, or the visit may not be covered. |
| Package balances that differ between Jane and the spreadsheet | 41 | See part 5. |
The median chart note is signed 2 days after the visit. By practitioner the median runs from the same day to 9 days. From your data
12What breaks if you are away for a month
- 22% of booked hours stop. You deliver 1,365 of the 6,091 yourself.
- Practitioner 2 delivers another 26%. If that one person leaves, a quarter of the schedule goes with them.
- One insurer is 13.4% of revenue, on a fee schedule from 2022.
- One front desk person holds the insurance follow up. Nothing is written down.
- The waitlist and the package tracker live in one spreadsheet that two people edit by hand.
- Licenses and malpractice renewals are tracked nowhere. Each practitioner keeps their own dates.
- You owe $25,500 in prepaid visits to patients who have not been seen in 180 days.
None of these is a crisis today. Each one could become a crisis with a single event.
13What AI is worth using here
Sannidhi signs a business associate agreement with the practice before it reads any patient record. No message described below contains health information, and none is sent without a person at the clinic approving its wording first.
Worth doing now
- A text back within a minute to every missed call from a number that is not in Jane, and a same day reply to every website and Meta inquiry, written in your voice and approved by you once.
- An offer to the waitlist when a slot opens. The people waiting for that practitioner get a text, and the first to say yes gets the slot. Your front desk confirms it.
- A weekly list for each practitioner: new patients who left with nothing booked, and patients reaching 90 days quiet, each with a short note drafted for the practitioner to approve or change.
- A weekly check of arrived visits against charges, signed notes and claims, so nothing delivered goes unbilled and no rejected claim sits.
- Drafted replies to reviews, worded so they never confirm that someone is a patient.
Not worth doing yet
- AI that listens in the treatment room and writes the chart note. Your median note is signed in 2 days. The 143 late notes belong mostly to two practitioners, and that is a habit to fix, not a typing problem. A recording in the room also needs each patient's consent. Revisit it when late notes are near zero.
- An automated voice answering your phones. Your patients praise being listened to. A text back keeps a person on the other end.
- A website assistant that answers health questions. Advice about a person's symptoms belongs with a licensed practitioner. A wrong answer here costs more than a missed inquiry.
- Replacing Jane with a larger software package. Nothing in this analysis is caused by Jane. Several findings come from features of Jane that are switched on and not used. Switching would cost months of disruption and fix none of it.
14The options, the three fixes and the scorecard
Option A: do nothing. The practice stays profitable. The losses in this document continue at roughly their current size, and growth has slowed from 9.1% to 3.2%.
Option B: fix it yourselves. Everything here can be done by your own front desk with this document as the plan. The limit is time: the 13 hours a week your front desk spends on cancellation calls and the spreadsheet are the hours this would need.
Option C: Sannidhi does it. The three fixes below, in order.
| Fix | What gets done | What it is costing you | Cost |
|---|---|---|---|
| 1. Answer and refill | Text back on missed calls. Same day replies to website and Meta inquiries. The waitlist moved into Jane, and every cancelled slot offered to it. The source of every new patient recorded. | About $26,100 a year. Our estimate | Included |
| 2. Keep patients | The next visit offered at the desk before every new patient leaves. A weekly list of patients going quiet, with a note for each practitioner to approve. A reason recorded when a patient stops. | About $25,800 a year. Our estimate | Included |
| 3. Bill every visit | Weekly match of arrived visits to charges. Rejected claims sent again where the deadline allows. Late notes listed for each practitioner every Monday. Package balances settled in Jane. Old logins removed. | About $10,100 a year, plus up to $6,200 once. Our estimate | Included |
Together the three problems are costing you about $62,000 a year, or 5.4% of revenue. Your own 12 hours a week are not counted in that figure.
Every cost, stated plainly
- Sannidhi: $500 a month.
- New software: none. Two tools are cancelled, which saves $118 a month.
- Your time: one hour a week to read the Monday report and make the decisions it asks for.
- Each practitioner's time: about ten minutes a week to approve the notes to their own patients.
How the estimates were built. Fix 1 is $16,900 from unanswered inquiries plus $9,200 from 106 refilled slots at $87. Fix 2 has two parts. If 80% of new patients left with a visit booked, against 62% today, that is 108 more patients booked. Patients with a booking return at 90% and those without at 35%. People who book are more committed to begin with, so we assume half of that difference is caused by the booking. That gives 30 more returning patients at $610, or $18,300. The second part is 5% of the 412 quiet patients returning, 21 people at $357, or $7,500. Fix 3 is the 116 unexplained visits at $87.
What comes first. Fix 1 starts in the first week, because it is what you asked for. The four old logins are removed the same week. Fix 3 starts with the 68 rejected claims, since some are close to their deadline.
Your scorecard
These are your main numbers as of 30 September 2026. The same ten are measured again every quarter, and your Monday report tracks them in between.
| Main number | Today | Where it comes from |
|---|---|---|
| Revenue, last 12 months | $1,150,000 | QuickBooks |
| New patients, last 12 months | 612 | Jane |
| New patients who came back a second time | 69% | Jane |
| New patients who left the first visit with the next one booked | 62% | Jane |
| Open hours that were booked | 71% | Jane |
| Late cancelled slots that were refilled | 18% | Jane |
| New inquiries with no reply | 229 a year | Quo, website form, Meta Ads |
| Patients quiet for 90 to 180 days | 412 | Jane |
| Arrived visits with no charge and no explanation | 116 a year | Jane |
| Your hours a week on office work | 12 | Your estimate |
What we could not tell from your records
- Why patients stop coming. Nobody records a reason. A one line reason in Jane, when a patient is marked inactive or declines to rebook, fixes this from now on.
- Which phone callers became patients. Calls and bookings are not linked. Recording the source on every first call closes this gap.
- Whether a visit with no charge was meant to be free. 116 have no note either way. Only you and your practitioners know.
- How many rejected claims can still be paid. That depends on each insurer's filing deadline, which your biller can confirm.
- How long your own office work takes. We have your estimate of 12 hours a week and nothing to check it against.