Hiring a med spa SEO agency in 2026: 10 questions to ask (and what an honest agency won’t promise)

Hiring a med spa SEO agency in 2026 means three jobs: a website patients can read, listings that match it, and a fair chance that ChatGPT, Perplexity, or a Google AI answer can describe the practice. Nobody can turn that into a promised ranking or a promised mention.

This note is for an owner in Austin, Dallas, Miami, or another US city. It follows Google’s page on hiring an SEO, AI features and your website, and the FTC’s questions and answers on the Consumer Reviews and Testimonials Rule. AI answers vary between people and over time, and we never promise rankings.

See the ChatGPT checklist, the October 18 city notes, and how the three products pick a local business.

What a med spa SEO agency should actually do in 2026

Google’s hiring page lists a content review, technical advice, content development, keyword research, market experience, and optimizing for generative AI. A small local business can do much of this, and Google points owners to its SEO starter guide first. A hire still fits a new site or a redesign, and it can help an existing site. An irresponsible agency can damage the site and your reputation, and you stay responsible for what they do.

For a med spa, split the work four ways.

The website. AI features and your website says ordinary SEO still applies to AI Overviews and AI Mode. There is no extra requirement and no special optimization. A supporting link must be indexed and eligible for a snippet, and even then Google may not crawl, index, or show the page. Put the facts in text and link each service from the homepage. Pixelmosa builds that kind of site on custom websites.

The Google Business Profile. The AI features page lists an up to date profile among ordinary habits. Google’s optimization guide says a profile can help services appear in AI responses and in other Search results. “Can help” is not “will name you.” Name, address, phone, hours, services, and photos should match the practice you run today.

The other listings. Use that same name, address, and phone on the website, on Yelp, and on directories a check for your city cites. The October 18, 2026 notes are one logged-out run, not a quota. Fix profiles you can name. Do not invent a source that was cut off.

The AI answers. Ask a real question on a stated date and write down what came back. The optimization guide says Google Search ignores llms.txt and other special AI text files, so creating one neither helps nor harms visibility there. The AI features page says AI Overviews and AI Mode need no special schema.org markup. Matching structured data can still support ordinary rich results. That is housekeeping, not a ticket.

10 questions to ask before you sign

Google says to interview the agency and to notice whether they care about your business. Ask these of us, and of anyone else.

• Can you show work for a business like mine, and may I speak with them? Google says to ask for examples and references. We will not invent client stories.
• Do you follow the Google Search Essentials?
• What should change, on what timeline, and how will you measure it? If the answer is first place in Google, find someone else.
• What is your experience with med spas, and in my city?
• How will we communicate, and will you explain every change to the site, and why?
• For an audit, will you start with read access to Search Console, not write access? Google says write access can wait.
• Do you use a tool that claims Google approved it? Google does not endorse third-party SEO tools, and they lack Google’s internal ranking data.
• Does your advice on AI answers match Google’s published pages? A special file or a new schema type is not that guidance.
• How will you ask for reviews? Will anyone be paid, or offered something, only for a positive review or only for a negative one?
• What will the monthly note contain, and what will you refuse to promise?

Red flags: guaranteed rankings, llms.txt or schema magic, and fake review schemes

Google’s hiring page says no one can promise a number one ranking on Google. Walk away from a promised ranking, a special relationship with Google, a “priority submission,” or a claim that edits will put you first. If they will not explain the work, keep the site. You should not have to link to the agency, and link schemes or blasts to thousands of search engines are not the help Google describes. Deceptive pages made for you can remove the site from Google’s index.

Treat llms.txt and a special “AI schema” the same way. The optimization guide says Google Search ignores llms.txt. The AI features guide says you need no new machine-readable file, AI text file, or special markup, and no special schema.org type for AI Overviews or AI Mode. Leading with either is a shortcut Google has set aside.

Fake reviews are the third flag. The FTC’s questions and answers say the Consumer Reviews and Testimonials Rule took effect on October 21, 2024. Agencies, public relations firms, review brokers, and reputation management companies are not immune. They can be liable for writing, creating, or selling a fake or false review, and for pay or incentives tied to a positive or negative sentiment. Asking after a real visit is different. Buying reviews, or paying only for praise, is the scheme to refuse. The same page says asking only happy customers is not specifically banned, and that it can still violate the FTC Act. Google’s hiring page points US complaints about deceptive practices to the FTC.

How to ask for proof

Ask for a count in the form named X of N. The note should name the engine, the date, whether the session was logged out, the exact prompt, and how many runs N is. One screenshot is one run, not a finding about next month.

The October 18, 2026 write-up is that kind of limit: one logged-out question per city, for Austin, Dallas, and Miami, and not a ranking. A report that hides the prompt, the date, or the number of runs is a slogan.

What monthly reporting should look like

State what changed on the website, the Google Business Profile, and the other listings. State the prompts, the date, the engine, whether the test was logged out, and the named X of N result. State what you will not do next month. Label Search Console figures as Google’s, and label repeated questions as what that test saw. Do not paste a rank chart and call it a promise. Third-party tools do not have Google’s internal ranking data, and a page that meets the technical bar can still go unshown.

How we work at Pixelmosa

Bruce Rosier runs the check, the plan, and the monthly review. For a US med spa the work is websites, SEO, local SEO, and visibility in AI answers. Published checks so far focus on Austin, Dallas, and Miami. Yours still has to be run for your city.

The free AI visibility check is one logged-out ChatGPT question for your service and city, a screenshot, and a short look at directories, listings, reviews, local mentions, and the website. It is not a ranking.

You approve a written scope before any paid work. This page lists no price. Setup can include treatment pages, a completed Google Business Profile, one name, address, and phone everywhere, Yelp, and directories that city’s check cited. Reviews mean real visits a reader can find, not a bought count, plus a baseline test and a written note.

A monthly scope, if you choose one, keeps listings accurate, watches directories and local mentions, and reruns ChatGPT with screenshots. Perplexity is included only when the scope says so. Small fixes sit in that month, and priorities reset about once a quarter. None of it promises a mention, a ranking, or a booking count. Clinics in the city notes are test examples, not Pixelmosa clients.

Start with a free check

Use the ten questions before you sign with anyone, including us. Book a strategy call to walk through the site, the listings, and a current answer. Or read your own answer first on the free AI visibility check.