The True Cost of a Booked ADHD Assessment: Why a £60 Lead Is Bankrupting Your Clinic

What a £60 lead costs once it reaches the diary

A cost per lead prices a conversation. The number that pays the psychiatrist is the cost of a booked assessment, and the two can move in opposite directions in the same month without anyone in the account noticing.

Start with the funnel published in The UK Private ADHD Clinic Growth Index. Across the private ADHD clinics we work with, 48% of enquiries reach a triage call and 58% of those book, so 27.8 enquiries in every 100 become an assessment. At a cost per qualified assessment of £340 in London and £275 in regional UK, each enquiry is costing roughly £95 and £77.

Now put a report in front of that clinic showing a £60 cost per lead. The £60 is our illustration rather than a benchmark: it sits well below the £77 to £95 our own funnel implies, which is exactly why it reads as a win. A London clinic spending £2,000 a month at £60 a lead gets about 33 enquiries instead of 21.

Whether that is good news depends on one rate. If 27.8% of those 33 enquiries booked, the clinic would have just over nine assessments at about £216 each. If 17.6% book, it has the same 5.9 assessments it had before at the same £340 each, with 27 enquiries that never book instead of 15.

In the monthly report the two accounts look nothing alike. One shows 21 leads at about £95, the other 33 at £60, a cost per lead down 37%. The clinic diary, the only place the difference is real, shows the same 5.9 assessments in both.

Each enquiry that never books absorbs about 18 minutes of reception and coordinator time, roughly £4 of wages at the NHS band 3 rate of £13.17 to £14.05 an hour for 2026/27. Twelve extra dead-end enquiries a month add about 3.7 hours of admin, or £48 to £51. At break-even the cheap lead already costs more than the dearer one, because the advert is not the only bill.

Then run a harder case, as a stress test rather than a measured rate: one in ten of the cheaper enquiries books. The clinic gets 3.3 assessments for its £2,000, a cost per qualified assessment of £600, or 63% of the £950 median fee found by a June 2026 survey of 41 UK clinics.

On a £950 assessment, a £380 cost per qualified assessment leaves £570 for the psychiatrist, the room and the report. At £600 it leaves £350. That is how a cheap lead bankrupts a clinic: one assessment at a time, while every monthly report shows cost per lead going down.

Why the cheapest enquiries are the least likely to book

Cheap leads are rarely an accident. They are what an account produces when it is told to find as many conversions as possible and nobody has said what a conversion is worth to the clinic.

Google Ads uses primary conversion actions both to report results and to steer bidding. When the primary conversion is a form submission, Maximize conversions spends the budget on as many form submissions as it can find, and it learns quickly which searches produce them cheapest.

In ADHD those searches are predictable. Queries about free assessments, waiting times or NHS referral come from people early in their research, who complete a short form in seconds. On our accounts, 65% of enquiries reaching a private ADHD clinic come from people who will find the free Right to Choose route before they pay, and bidding that chases the cheapest form finds more of them, not fewer.

Calls are counted the same way. Google records a call from an ad as a conversion once it lasts longer than a minimum duration the account sets, whether it ends in a booking or in a question about NHS funding.

The search terms report shows the queries behind every cheap conversion, but a generalist account rarely reads it against booked outcomes. The account ends up optimised for the stage of the funnel furthest from the fee.

Then the monthly report closes the loop the wrong way. Cost per lead is the headline figure in most generalist reports, so a falling number earns a bigger budget, and the bigger budget buys more of the same cheap forms. The account is rewarded for the very traffic that raises the cost of each patient.

None of this is hidden. The account measures what it was set up to measure, and in an ADHD clinic that means the enquiry. We covered what that costs at the intake stage in Why 70% of your ADHD leads never book an assessment, including the five form questions that filter free-route shoppers before anyone calls them back.

When a £60 lead is a good lead

A low cost per lead is not a bad sign on its own. A £60 enquiry that books at the published 27.8% produces an assessment for about £216, comfortably inside any ceiling a clinic is likely to set.

Cheap and qualified does happen. A search for the clinic’s own name, a tightly matched local term or a landing page that states the fee before the form can all produce low-cost enquiries that book. The test is the booking rate attached to the price, never the price alone.

The working rule takes one division. Divide the cost per lead by the cost per qualified assessment you can afford, and you have the minimum booking rate that source must reach. At £60 against £340 the answer is 17.6%; against £275 it is 21.8%.

Regional clinics have less room than London. With 27.8% of enquiries booking, a regional source can lose six points of booking rate before a £60 lead stops being cheap, against about ten points in London. The cheaper market is the less forgiving one.

Put numbers on a regional clinic. A £60 source booking at 20% produces assessments at £300, which looks fine against a £950 fee and still costs £25 more than the £275 the clinic paid before the cheaper leads arrived. A source can be cheaper per lead, affordable per patient and still a step backwards.

The landing page moves that rate more than any bid change. A page that shows the fee, the clinician’s GMC number and the CQC registration loses some form fills and keeps the ones that matter, and it is also what Google’s reviewers check, as set out in our Google Ads compliance guide for ADHD clinics.

How to work out the ADHD clinic cost per qualified assessment you can afford

UpMedico starts from the fee, not from the keyword list. The ceiling on cost per qualified assessment is set by what an assessment leaves once it has been delivered, and every other target in the account is worked back from it.

Five steps, each using a number the clinic already holds or can measure within a quarter. The definitions match the ones in The Executive Scorecard for psychiatry and ADHD owners, so the two can sit in the same monthly report.

Once those outcomes exist, send them back to the ad account. Offline conversion imports let booked and attended assessments train the bidding in place of form fills, so the algorithm learns the price of a patient rather than the price of a form. The setup is covered in our guide to offline conversion tracking for UK clinics.

When a source misses its minimum booking rate for two full intake cycles, the options are short: tighten its keywords, add the search terms behind it as negatives, or move its budget to a source that clears the bar. Raising the bid on a source that does not book only buys more of the problem.

Read the result monthly. Assessments are often booked several weeks after the first click, so a cost per qualified assessment worked out on one week of data will mislead, in either direction, and usually towards whichever decision someone already wanted to make.

The numbers behind one booked ADHD assessment

The table puts the published rates next to the cost lines derived from them. Every derived line is arithmetic on the rows above it, so a clinic can rebuild it with its own figures in a spreadsheet in ten minutes.

Read the implied cost per enquiry against the cost per lead in your agency report before anything else. A figure below £77 to £95 is not good news until it arrives with a booking rate for the same enquiries.

The admin line looks small and is the one owners underestimate, because it is counted per booked assessment and grows with every enquiry that does not book. The attendance line is where a deposit pays for itself: four points of attendance take about £16 off every London assessment.

Then compare the two columns. The regional cost per enquiry is lower, but so is the room a cheaper source has to underperform: a £60 lead needs 21.8% of enquiries to book there, against 17.6% in London. A regional clinic should be the first to ask what its cheap leads actually book.

Where the booking rate is decided: on the phone

In our call tracking data, 58% of ADHD enquiries in London and 47% in regional UK arrive by phone. Roughly half of the booking rate in this article is set in conversations the ad account cannot hear.

That is why a £60 lead cannot be judged from a dashboard. Two sources can produce the same number of calls, and only the recordings show which callers asked about the fee and which asked whether the NHS would pay. Clinics typically start at around 24% of calls from ads ending in a booking, against a target of 31% to 35%.

Recordings close that gap. Each call is scored against the clinic’s intake script and tied to the keyword that produced it, so a cheap source can be judged on bookings within weeks instead of on volume for months.

Up to 20% better call-to-booking conversion within 90 days takes a clinic starting at 24% to about 29%. Because cost per qualified assessment is spend divided by bookings, every extra booking from the same calls lowers it without another pound on ads.

Recording those calls means processing data concerning health, which is special category data under UK GDPR. It is configured accordingly: a consent message before the call connects, a defined retention period and access limited to the people who need it. The wording your reception team can adapt is in our clinic phone script, and the setup in our note on call tracking for clinics.

If your current agency cannot say which keywords produced last month’s booked assessments, the questions to put to it in writing are in our comparison of Google Ads agencies for ADHD clinics. Cost per lead is a fair number for the people running the account; the person paying the psychiatrist needs the one in this article.

Frequently asked questions