The Chiropractic Recall Ladder That Reactivates Patients

If every ad account got shut off tomorrow, could your chiropractic practice still grow, or would your pipeline go silent? We challenge that fear head-on by looking at the most overlooked growth engine in chiropractic marketing: the database you already own. Most clinics have hundreds or thousands of past patients and leads sitting in their CRM, EHR, DMs, workshops, and website forms, and the real problem is not “no demand” but no system to wake that list up. 

We break down why patients actually stop coming in, and it is rarely because they hated care. Life gets busy, pain fades, reminders stop, and people drift. That’s why we focus on reactivation, not selling. You’ll hear a clear, repeatable “recall ladder” you can run quarterly: friendly text check-ins, educational emails, personal phone calls, doctor video touches, and even old-school mail that still gets opened. We also talk about how to teach care frequency in a way patients understand, so a wellness check feels normal instead of random. 

Then we zoom out into the systems that make this sustainable: annual wellness recalls, birthday marketing, family recall prompts that spark real conversations, and referral scripts that fit naturally into table talk. We close with the practical backend: segmentation that prevents embarrassing blasts to active patients, a simple monthly reactivation calendar, and automation tools that support relationships instead of replacing them. 

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Transcript

Your Dormant Patient Database

SPEAKER_00 0:27

Will we keep you ahead of the curve, attracting more new business and growing your business? Now here's your home. There's the hump.

SPEAKER_01 0:44

If I took away every meta ad, every Google ad, your SEO campaign, could your practice still grow? For most chiropractors, the answer is no. But here's what's crazy. Many clinics I talk to have 1,000, 2,000, 5,000, sometimes even 10,000 patients sitting inside of their database doing absolutely nothing. The database isn't dead, it's dormant. And today I'm going to show you how you can wake it up. Welcome back to Marketing 101 for chiropractors. I'm Dr. D. And every week we bring you tips and ideas to help grow and scale your business. Recalls and your database is something that is such a staple in every business, yet alone healthcare. You're sitting on a gold mine, and I know you know it, but how do we cultivate it and embrace it more? This is your greatest asset, and most clinics ignore it. Most clinics have active patients, they have inactive patients, then they have leads that never booked. This should be in some CRM somewhere. They have workshop attendees from 2021. They have website leads from their SEO and their website, they have Facebook leads, they have family members, they have contacts, they have DMs, they have Instagram messages. Where are all of these data-based people? When was the last time you intentionally marketed to any of these people?

Why Patients Stop Coming Back

SPEAKER_01 2:20

And you know, most doctors can't even say the last time they did. So let's talk about why patients leave. Why do we have inactive lists? Well, it's just normal attrition of any business, even restaurants, all these things, people stop going to them. Uh in healthcare, same thing. The utilization rate may go down, or they may just take a break, or they move away, they die. There's reasons why people stop coming in. But the answer is not usually because they got better. And that's where I think a lot of us default. They got what they needed and they moved on. Well, this is important. Patients disappear because life gets busy. That's the bottom line. Kids, vacations, money, change of job, loss of job, laid off, no reminders, pain decreased. They forgot. They simply forgot. Not because they hated you. People don't wake up thinking, I'm never gonna go back. No one wakes up the next day after an adjustment and be like, I'm never going back, unless you did something that's weird or wrong. They simply just drift away. You do it too. Think about all the things you consume and all the places you go and why you stopped going. When was the last time you went to this place? When was the last time you saw that doctor? When was the last time you got your skin checked at a dermatologist? When was the last time you had an eye of the eye exam? I just went yesterday. And uh my optometrist was like, Hey, last looks like the last time we saw you is 2023. I'm like, what three years ago? I thought I saw you like a year and a half ago. Like, no, it's been three years. I'm like, wow, there you go. See, but I'm back. I came back on my own, called. They never recalled me, right? They simply just drift away. These this changes how we approach recalls is by understanding this. We're not calling them up for a sale, we're calling them up for a reactivation. And a reactivation is about healthcare. So this is what I call the recall ladder. Ladder. You want to build a ladder and we want to cycle through this ladder quarterly every year and keep this system and SOP going

Building The Recall Ladder

SPEAKER_01 4:20

in your practice. Instead of one text, hey, it's been a while, uh, create multiple touches. So the first one that you do, the day one, is a text. Simple text. Yes, they have the automations in your CRMs, in your sched, in your in your uh review wave after a certain amount of time. Usually it's 30 days. You can set some parameters, they're still not that great. Um, but you you have to get in there. And what we do is every week or every month, we go through it and we look back a month from ago. So if today is the the 21st, we go back to the week of the 21st last month, and we just look at the people on the schedule that day. We start with the day, and we're like, oh, Sally, where's Sally? Sally hasn't been in. What the heck? Where's Sally? And we'll go through the week and we'll look at it and be like, oh, geez, Jerry, Sally, Michael, man, we were seeing them and then they stopped. And we just sent out a friendly text. Hey, Michael, we were reviewing our patient files today, and we noticed that we haven't seen you in 30 days, in a while. How has your back been feeling? And you can do this for anything 60 days, 90 days, 12 months, 24 months. You can just whatever. It's been a while since we've seen you. Then they get an email, an educational email, not a recall or a resell. It's five signs your spine needs attention. Create that email. And once you create these, you have it. It's on auto-populate. You just resend it. You put another person in, they get the whole sequence. Then a few days later, let's say day one, then day three, they get an email. Day seven, they get a phone call. It's personal, right from your office. No sales, just checking in. And usually I like it from the doctor. You can even do a video and be like, hey, Mike, it's Dr. Enrico. Haven't seen you in a while. Uh, just sending you a quick video because I know you probably don't check your text, your emails, or your voicemails. So I thought maybe a video would be a little bit more, a better touch point. Checking in on you, thought about you. I have no clue why I thought about you, but I thought about you twice. And I said, maybe I should check in and see how he's doing. Hope everything's okay. You send them that video or that voicemail. Or maybe you even get them on the phone and you say that. Very powerful when that happens. Then you have something in the mail. There used to be postcards back in the day. We miss you, include an offer. It could be a letter. Uh, we have a ref uh recall letter that we send out at 60 days. Sorry, 90 days, 12 months, and 24 months. We have three. The 90-day recall letter, hey, it's been a few months, time for a checkup, uh, stay on track with your care, frequency. Chiropractic is the best utilized with a continuous frequency. And you just plant that seed in their head. I have this discussion with patients almost every week. Is like chiropractic works its absolute best with a frequency, a routine, just like cleaning your teeth every six months, just like exercising every day, just like eating nutrition every day, just like getting your eyes checked once a year. It's a frequency that we pick to do this. You floss every single day, you get your teeth professionally cleaned every six months, your spine gets checked every month, twice a month, once a week, depending on where you're at in life. Uh, and we tell them the frequency. I say most families are coming in weekly. Believe it or not, their kids are getting adjusted weekly because of how fast paced life is with little kids. Mom needs it, dad needs it, the kids absolutely need it. They come in, it's frequency, they have nothing wrong with them. They're just getting adjusted every single week. So families tend to go every week or every other week. Retirees, people on their own, empty nesters tend to tend to go every other week to maybe once a month, somewhere around there. They're getting checked 12 to 24 times a year. But that's my uh guidance for you. You pick the frequency. That's where chiropractic where it stacks on top of one another based on frequency. Long breaks, just like exercise, if you take a long break from the gym, you lose strength. Same thing with the tone and frequency of your nervous system. If you continuously tune the piano, you continuously play beautiful music. That's the way it goes. That's how you use it the best. And that's how I teach my patients about it. So when they get these recalls and they hear stuff like frequency continuation, they understand. It could be a postcard, it could be a simple five by seven, it could be a piece of paper in an envelope. We do it that way. It's just a piece of mail, it's handwritten with the address on there, and it has full life chiropractic on the return label. They tend to open these. So they get that. Then week three, a video email. You record a video, you post it to YouTube, and you continuously use that email over and over again on automation. Doctor, personally speaking about the frequency of chiropractic. And then about a month later, they get a final reminder. Uh, we're here whenever you're ready. It could be a text, it could be an email, and that's your nurture sequence for that particular time frame that you choose of an active patient. So let's say that's a 90-day sequence that you do. Once somebody hasn't come in for 90 days, hopefully your CRM triggers this, and you've got this automation that automatically kicks in and they can send it. Or your team has a way to follow that up. They get a notification, they're like, oh, I have to enter Michael into the 90-day reactivation sequence, and all they do is pop in his name into the contact and trigger sequence in your other CRM, high level typically. You go into the automation, trigger contact. You tag them, 90 day. It starts it right there, starts them on their 90-day sequence. Then you have one for your six month, your 12-month, your 24-month. Uh, once you build these, you're ready to rock and roll. So persistence matters with this. That's where I think it all falls apart. And believe it or not, with the more AI and automations we have going on, I think it's even more complicated because now people back in the day, I we had our systems. Like I remember our front desk CAs would just know what to do. They had the the 90-day, the 12-month, and the 24-month. And they would always, every week, there'd be three, four, five, six, seven envelopes stamped, ready to be thrown in the mail for that letter. We had email, which was a little bit better back then, you know, 15 years ago, people opened up their email. Text wasn't a thing at that time. There wasn't that much texting. I remember when Cairo Touch came out with the auto reminders. Um, it was typically email when it started. So I'm just telling you, back then, I mean, when you threw something in the mail, people opened it. So there was that. Then now it's just all this automation. You're building

Teaching Care Frequency Without Selling

SPEAKER_01 10:50

so much back end digital stuff that I think it's complicated. It's complicated and it seems like a lot of work to do. But but the value in this is the automation. Once it's created, it's and it works and it plugs, it's really useful. And then, and then you got that standard of standard of care, repeated care that you're doing. Annual wellness recalls, these ones are great, the one-year anniversary ones. This is what most EHRs have is the last appointment date. And you can have a trigger on that to remind, send in a reminder to the front desk or send a reminder to the doctor saying this person hasn't been in. If you have a third-party app like SCED or something, it can you can automate it saying at 365 days, send an automatic. If they haven't been in for 365 days, send an automatic text. You can do those things as well. They're still messy on a lot of these, uh, a lot of these reactivation ones. This is the one that not very many people do. They like the idea every time I bring it up. So I thought I'd put it on a podcast. So your dentist, your eye doctor, your primary care gynecologist, veterinarian, uh, chiropractors do their wellness checks too. You should be doing a wellness check. So you call them up, you send an email, you send a text or a voicemail saying, hey, it's been a year, it's time for your spinal wellness check. Give us a call back. You're due in. We can get you in in the next seven days. Call us back at, you know, our phone number, and we'll get you all booked in. Time for the wellness check. They may confuse some of your patients if you didn't do a good educational program with them. For others, they're like, oh man, it has been a year. And then for others, they may ignore. And then others may actually call you back and be like, hey, you know, I got this insurance now. I was wondering if you take it, it opens up a discussion, or I switched providers. I'm actually still seeing a chiropractor. Those people tend to not want to call you back because they feel ashamed that they did choose another chiropractor, but that's fine. You may you may have a conversation with them. So you can do the annual posture scan, posture assessment, nervous system assessment, nervous system scan, movement assessment, x-rays, if appropriate, if you take them, wellness consultation. Then it creates a predictable visit for them. Birthday marketing. I like the birthday one. Birthday cards on a man, we do a lot of birthday cards. We just at the beginning of the month, we see who's got a birthday that month, and we try and do as many of them. Uh, our our data list is big, so we pick and choose

Wellness Recalls And Birthday Marketing

SPEAKER_01 13:15

who to send to. And the CAs tend to default to the current patients. They do because they they want to reward the current patients that are coming in. I told them that's a little counterintuitive. Don't you think you want to be sending the birthday cards to the inactive patients as a reactivation time? They're like, that's that's cool, but that's larger than our activation. I'm like, true, but what's a few extra bucks to send some extra a card costs less than a dollar and stamp costs less than a dollar for so for less than two dollars? You're sending out something to them. It adds up. I mean, you're spending a few hundred bucks on stamps, but better than a few thousand dollars on meta-ads or um testing, you know, advertising. You could try that. You can have, or you can have automated ones, you can have a text too. You can use your text provider and send out happy birthday text. We do that automatically. Everyone gets a happy birthday text. These are automated, they get a happy birthday text, they get a gift certificate, a free class, a free scan, a discounted massage, a red light session, uh, kids checkup, just no selling. You're just giving them something for their birthday. And the card can be enough. Happy birthday, thinking of you, have a wonderful day. Send it out. Family recall campaigns. If you do have family practice, this is huge. Ask, when was the last time your children were checked? Boy, do you want to get to a parent? Do you want to hit an emotional string with parents? Children. Chill. I just had this talk with a mom yesterday. I'm like, man, have we checked the kids for their upper cervical evaluation? Because she comes in, that's it. You're not allowed to touch anything else. I'm not allowed to assess her hips, not allowed to assess anything. She doesn't want an activator adjustment on her thoracic, nothing. She comes in, check my C1 and my C3. She's been doing it for 20 years. And she comes in, and her husband was trained on that as well. And then I'm like, hey, how about your kids? She's like, I want to get my kids checked so bad. My husband is against it. He doesn't think kids need to be checked for anything. It was a great conversation. Opened up a conversation, but boy, did I get a heartstring there. She's typically simple two-word answers. But when I ask, have you got your kids checked? Boom, she gave me a whole description of like, oh man, I've been meaning to get my kids checked. Uh, but you got I need to convince my husband. He's just he's solid about this. Then he comes in like three hours later that same day to get his neck checked because they're heading out for uh uh vacation for a week. And I got a chance to talk to him. I heard I'm like, I heard your wife said you don't want to get the kids checked. He's like, Yeah, you know, I don't really think they need any type of cracking or assessment. I'm like, we're just doing the upper cervical. Do you think if they have a brainstem occlusion or at C1 or C2, it could be affecting their optimal potential? He's like, Oh, and if they had anything and I had to do this, big deal. And we don't even have to do X-rays. I could do the titron scans, I could do the leg checks, we can find it that way. Like we used to do old school. I'd love to do an X-ray assessment. But if that's what's holding you back, he's like, Yeah, it was actually the X-rays. I'm like, let's skip them, let's do the scans. They're non-invasive. He's like, That's right. Okay, I'll book them in when we get back. Boom, got their two kids getting checked for upper circle. Pretty cool stuff when you have that discussion with people. So, recall campaigns allow communication uh channels to open up again. That's the whole point of this. And I think we don't see the immediate results like when we set up an advertising campaign on Meta and the leads start coming in. We're like, okay, metrics. I can see we got seven leads, we spent 400 bucks. I can see what's going on. Three of them we got on the phone, two of them are new patients for 700 bucks. I got two new patients, that's 350. Like we can do the math with recalls, it's it's hard. So we do all of this work. We reach out to 1700 people in our database to book an appointment. And we're like, that's crazy. 1700. No, it's not. I mean, that

Family Reactivation And Referral Scripts

SPEAKER_01 17:00

was literally free marketing. Emails and texts and phone calls to your database who's responsive. Two of them are like, holy smokes, it has been a while. I do need to come in. Yeah, I don't understand why we don't look at that differently. When was your last time your children got checked? Or has your spouse ever been evaluated? Many patients never think about family care, they're coming in taking care of themselves. So don't ask, do you know anyone when you're asking for referral? So table talk matters. If we're always talking about the World Cup and we're talking about soccer and we're talking about sports and the weather, then we might miss the boat on this. Table talk matters. You don't want to start with do you know anyone that has a spinal issue? You know, instead, we want to create moments. Moments. Examples are like after a great progress on their scans, we say, Hey, anyone else you think needs to have this type of improvement in their nervous system? Uh, pain reduction. Hey, if we helped you with this rotator cuff thing and this neck thing or this headaches, do you know anyone else suffering from headaches that may benefit from this as well? Give them our card. A good review, that's a great barrier uh conversation starter. When someone leaves you a review next time they come in, hey, thanks, Sally. That review is so great. I really appreciate you. Thanks for doing that. Really helps us. Um, do you know anyone that could also get the same results you did? Weight loss, pregnancy care, headache relief, sciatica, disc issues, spinal decompress, whatever you're doing, asking people, is there anyone else you know with disc issues? Do you know anyone else with migraines? That stuff starts and spurs referral type things. Then once they say, Yeah, you know what? Uh, my coworker at work, she's got headaches all the time. I'll tell her, hey, give her this card. And here, I'm gonna give you a gift of health and put your name on it, give it to her, and once she comes in, whether she brings this in or not, we'll give her a half off of her exam to get started. Tell her, hey, go see my chiropractor here. I got this for you. It gives you half off. Go in there, 100 bucks, you get started, and uh, he'll take care of you. So, referral scripts. Your CAs can say stuff like, Who else in your family would benefit from feeling good? I like that one. It's not asking them, you know, a direct question about pain, it's asking who else in your family, and then they'll have like a grandma or a sister or someone. The doctor could say, I'm accepting three new families this month. If any if someone comes to mind, we'd love to help them. That's it. You tell them what's happening on the business side. Hey, you know what? I've got some spots that have opened up in my uh schedule. We've had a few families move out of town. We have now room for a few families to get started. Moms with kids love to tell their friends with kids about what they do. They love it. And I've tried that a few times. I'm like, hey, a few spots have opened up. We a couple families have moved out of town. We've got room for to start a couple more families on wellness care if they qualify for wellness. Uh, just letting you know, because I know you hang out with a lot of families. So if they want to start care here, I'm open. My my schedule's open. Sometimes they even like that with the head doctor, they're like, oh yeah, he's busy, he's full, that's why he has associates. But he's opened up his, so I can get him directly. And maybe this is a small opportunity for us to get in. Just little things like that, the way people think. And then patient appreciation events. I'm I'm a fan of these. Uh, family fun days, food truck Fridays, movie nights, pumpkin patch, Santa Pictures, teacher appreciation week, first responders week, Mother's Day stuff, Father's Day giveaways, toy drives, backpack drive. We have kids' day. Uh, parents bring their friends just naturally to these things because the kids get to hang out and play around. Uh, I'm a fan of those. Annual, doing those annually, having two or three big events for the year. It builds community. And once you do it on repeat, you become the centerpiece of the community. They're like, oh, yeah, full life's doing that again, full life's doing that again. Educational referral events, um, host workshops, like headache workshops, sciatic workshops, detox workshops, which can wrap, which can go into headache workshops and migraines and how detoxing can help, neuropathy, pregnancy, kids, families, uh, desk workers, ergonomic workshops, weight loss, longevity. That's biohacking and longevity is huge right now. People will come to that one. Improving sleep, that's a that's a hot topic, but I found that the sleep workshops to get people to, they're like, no, I'm gonna fall asleep if I go to that. Encourage patients to bring a guest when you do these things, really helps because you get 10 or 20% of them that do bring someone, which is great. Gets you in front of instead of you know, six people, gets you in front of 10 people, which is nice. You got a group of 10, you talk about it, it works really well. You can do this monthly. So people refer to you when they trust you. Starts with trust. That's why we're working our active list. Those people are active because they trust you. Even your inactive list trusted you at some point. They're there too. You they get results, they remember you, they know who you help. Most clinics only focus on the first two the trust and the results. They forget about being remembered and they know who you help. They don't know who you can help. Even if you help them with my Migraines, they're like, Oh, I didn't know you could help with migraines. You taught me so much. I have a reverse curve, I have DDD at C4, C5. They remember I've got to work on my posture. I gotta get that curve back. I've got like that nerve irritation causing my migraines, but I thought it was because of my combination of stuff that you could help me. I didn't know you could help with migraines. I'm like, we just helped you with your migraines. Like, yeah, I didn't, I didn't know. I thought it was all that stuff. My brain stem C1 was off and I was tilted in my hip. And you told me, you know, don't do a foot lift in my shoe. And uh I thought that is what you do. I'm like, no,

Segmentation And The Monthly Calendar

SPEAKER_01 23:00

yeah, we do that too. But my migraines, we're pretty good at. Uh, and it's it's hilarious. 19 years later, I'm like, I think I'm just dumb. I think I'm just not communicating right, I don't know what to do. So making sure that you understand that you communicate better. Now, database segmentation is really important if you're gonna try any of this. Blasting your entire 6,700 people on your list, not a good idea because you can't really segment it to the right stuff. You're gonna get active patients in that list who are like, dude, I saw you on Monday. You sent me a re reactivation. We get it all the time, and there's always the data entry people, the analytical English majors that are like, hey, you sent me that, you know, I you were checking in on me. I was just in, I know, we just blasted the list. She's like, Yeah, I can tell. Uh, so don't blast everyone. You want to separate current patients, so you call them the active, then you want inactive of less than 12 months, inactive of 12 to 36 months, and then inactive of three plus years, 36 months more. Uh, Facebook leads, your weight loss leads, maybe you did like certain ads or leads for certain campaigns, decompression leads, neuropathy leads, pediatric leads. Uh, you definitely want to tailor to each group so that you can you can tailor message that as well. So your monthly reactivation calendar should look like this week one, the first week of the month, inactive patients. You're focusing on them. Week two, birthdays for the month. You're sending, making sure everyone's getting their birthday text. Week three, referral campaigns, and then week four, educational newsletters, and you repeat this every month. The monthly newsletter is a little cheesy, but if you have a series of emails that are going out all the time, a couple few times a week, you can go up to five days a week. You could be sending out emails. Honestly, like that's the day the literature shows that if you're sending out almost a daily email, they're gonna catch one a week where they open. And then you're gonna get two or three opens per month, which increases your open rate quite a bit. Because if you're just sending out a monthly email and they're just missing it every time, you're gonna have a very low open rate. So there's stuff around that too. They're not gonna read every email, but if they catch ones and they bring them a little bit of value, they're gonna make sure they check in and see what's going on. Technology does make this easier. Your high-level or CRM can do some pretty cool stuff. Text sequences, ringless voicemails where you call the phone number, it doesn't even ring. The intent of this is to leave them a voicemail, it goes straight to their voicemail. And then your voice, your voice memo drops as a voicemail. Email campaigns, task reminders, review requests, birthday automations, reactivation campaigns, referral tracking. Technology doesn't really replace the relationships you're trying to build. They just it reminds people that the relationship already exists. So I want everyone listening to this week's podcast to do one thing. Open

Automation Tools That Support Relationships

SPEAKER_01 26:00

your CRM. It might be your EHR, but your CRM, look at how many inactive patients you have and leads that you've developed over time. Multiply that number by your average case value. And that's pretty much the opportunity sitting in your database. Then build one recall campaign, not 10, one, because I'd rather see you reactivate 20 former patients who already trust you than spend another $2,000 hoping strangers fill out a Facebook lead form. So export your inactive patient list, segment them, launch a 30-day recall sequence that I showed you. That's really easy. Add an annual wellness recall automation and just double check your birthday uh protocol and what you guys do for that. And you're gonna create a system that really works for your practice. And you'll thank me later, even if you get this 50% done. It's gonna just help you stimulate those referral. People do want to come back and see you, they just don't know why. Or they forgot. That's usually the two things. They don't know why they need to be checked because they're not currently in the same pain that they were when they first came in, or they completely forgot about you. They're like, oh yeah, no, you did tell me to follow up. Geez, when was that? You're

Your One-Step Action Plan

SPEAKER_01 27:10

like November. Like, wow, it's August. Yes, it's August. They're like, come back, try it. Stay well, keep doing what you're doing. Your community needs you. That's why you're focusing on this stuff and keep growing.

SPEAKER_00 27:22

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