The Patient Loyalty Manifesto

Posted on April 1, 2022 by Amber Shepherd

This original article is featured in the April 2022 issue of The American Chiropractor.

Like most of you, I became a chiropractor to help others. I naively came out of chiropractic college thinking if patients knew what I knew, they would do what I do. However, my experience proved that it wasn’t true at all. I had plenty of patients who got the “big idea” of chiropractic but still dropped out. And plenty who never got it but stayed under care for years. Ever ask yourself, why?

There is nothing more frustrating in practice than working hard to get new patients only to have them drop out of care prematurely. I knew beyond a shadow of a doubt that if they had followed through with the treatment plan that I had laid out for them, I could help them get the desired results. Yet they dropped out when their insurance stopped, when the pain went away or when it was time to pay again.

I decided to do research in my practice to learn what drove patients to do the things they do. What made some follow through, while others dropped out. The things I discovered made me realize there was more to patient retention than simply educating my patients. With the knowledge I gained, I was able to master patient retention.

To put that into perspective, I was able to go from high patient dropout to high patient retention. When I finally retired from practice, my patient visit average (PVA) was just over 300. That’s 24 times the national average of 12. 

I learned not only to have high patient retention… but also to cultivate PATIENT LOYALTY!

Let me ask you a question. If there was an adjustment that you could learn that always resulted in 15% better clinical outcomes, would you want to know it? Of course, your answer is yes! 

Wouldn’t you agree that the most significant reason many patients don’t get the full benefit of care is not due to you not knowing this significant adjustment? It’s the fact that your patient fails to follow through and drops out early.

Patient retention is not about making more money, although you do. It’s about helping patients stay the course, follow through with their care to completion, and get better clinical outcomes.  The high retention practice, success, and financial rewards are merely the benefit to you, the doctor, for helping more patients get better results.

So, how do we build a high-retention practice? It’s simple. Focus on creating loyal patients. Patient loyalty is the cause, and high retention is the effect. 

How do you create a loyal patient? Well, that, my friend, is understanding what drives humans to do the things they do. In other words, have a basic understanding of the psychology of what drives human nature to do what they do. That is a discussion far too deep for the pages of this article, so to keep it simple, we know patients need four specific things to occur to become loyal.

Every patient has a journey they follow in your practice. And I want you to think about the type of journey they’re going through with you. Is care planned out and clearly communicated to the patient? Do your staff know? Do you feel you have to convince the patient to be there constantly? Do patients drop out because the pain stopped, their insurance stopped, or it’s time to pay again? 

I want to share with you the journey that I’ve mastered in my practice and have been teaching others to master as well. I call this the Loyal Patient JourneyTM or the LPJ for short. Throughout my research, I’ve also discovered that loyal patients need four things to become loyal practice members while on their healthcare journey, so we will be applying what I call the Four F’s of Retention to the LPJ. The Four F’s that loyal patients need are:

  1. Feedback that’s intuitive
  2. Forecasted Care 
  3. Frictionless Payments
  4. Frequent Contact

The LPJ consists of 11 distinct steps that help avoid the dangers that cause patients to drop out early and instead result in a loyal patient that stays, pays, and refers. 

When you complete the LPJ with every patient, you’ll end up with a practice full of loyal patients, giving you the high retention practice and the success you desire. 

Before we dive into these 11 steps, I want to remind you that each step contains one or more of the four retention principles. Let’s follow the doctor (played by you or me), the chiropractic assistant (played by Holly or your CA), and the patient (Scott) as they navigate through the LPJ. 

Let the Loyal Patient JourneyTM begin… 




Scott calls Dr. Bodzin’s office, and Holly cheerfully answers. After scheduling Scott’s first appointment, Holly assigns a new patient email campaign. The campaign welcomes him to the practice and includes information on what to expect at his first appointment.

Retention Principle: Frequent Contact

You do many things to build rapport from the very beginning. The way you answer the phone, the tone of your voice, the smile on your face, and so much more can create a healthy relationship!

When you go above and beyond to warmly welcome your patient with an email containing clear instructions on what to expect on their first visit, you put their mind at ease, build even more rapport, and make it easy for them to show up! 


After Dr. Bodzin performs Scott’s new patient exam, Holly collects his payment and assigns an email campaign to prepare him for the report of findings. All of this can be done in one easy step with the right systems. This ensures future payments are frictionless by securely and automatically storing their billing on file.

Retention Principles: Frequent Contact and Frictionless Payments


Dr. Bodzin generates a report card based on Scott’s exam findings. Scott got a “D”. Dr. Bodzin then builds a treatment plan including all necessary services to reach the goal of care and hands it off to Holly to prepare for the care plan presentation.

Retention Principle: Feedback

We’ve found that using letter grades is an incredibly effective way to get your patient to understand their need for care intuitively. Everyone knows what an A, B, C, D, and F signify. Picture the reaction your patient will give you when you tell them their health score is a D. This changes the conversation from, “Doc, what do you have to do to get rid of my neck pain?” to “Doc, what do we have to do to get me an A?” 


Holly enters Dr. Bodzin’s recommended treatment plan into the system, producing a comprehensive, customized, and compliant care plan with affordable payment options. This preparation will give Holly the confidence to successfully present the care plan to Scott at his report of findings.

Retention Principle: Forecasting Care

Depending on the tool you use, you’ll generate a comprehensive and compliant care plan that gives affordable payment options. Because the patient can see the end goal and has payment options that fit into their existing budget, they will feel more comfortable enrolling and committing to care. 


When Scott returns for the report of findings, Dr. Bodzin demonstrates Scott’s need for care by presenting the “D” grade from the report card. Once Scott agrees to the treatment plan, Holly then offers him a choice of affordable payment options displayed on the care plan, making it easy for him to say “Yes!” to enrolling in care.

Retention Principles: Feedback and Frequent Contact

Recommending care is one of the biggest challenges in getting patients to say yes. When you present the clinical justification for your patient to start care and the financial solution that makes it easy for them to purchase it, they will easily understand and feel confident in your plan of action. You’ll be amazed at how natural and easy it is to enroll patients into your care plan.

The one-two punch of showing the need for care along with affordable payment options avoids the danger ahead of hearing your patient say the dreaded, “Let me think about it.” 


In less than 60 seconds, Holly enrolls Scott into care. Using the right tools, Holly collects his first payment, schedules his recurring auto-debit, produces his copy of the plan, captures his electronic signature, and assigns a patient education email campaign all at once! Scott is officially enrolled and committed to care!

Retention Principles: Forecasting Care, Frictionless Payments, Frequent Contact

By doing this, you will avoid the danger ahead of your patients dropping from care when their insurance is exhausted or when their symptoms are no longer a motivating factor. These are two of the most common causes of patient dropout, so great job – you’ve neutralized them both!


Throughout care, Dr. Bodzin shows Scott the progress he’s making using report cards. Scott is excited to see his “D” become a “C” and then a “B”. All the while, his payments are automatically collected, and emails are sent educating him on the benefits of care. Altogether, the systems apply the 4 F’s to build patient loyalty.

Retention Principles: Feedback, Forecasting Care, Frictionless Payments, and Feedback

During their progress exams, you get to report to your patient that they went from a D to a C, then to a B, and eventually…to an A! Meanwhile, the other three retention principles are automatically being utilized during care and behind the scenes. Your patient’s auto-debits are running, their care plan is still in play, and the emails are going out frequently to educate them. By doing this, you avoid the danger ahead of losing them prematurely.

Imagine how confident you’ll feel when your patient reaches the end of their initial treatment plan, and you can present them with the good news that they’re ready to transition to the next course of care.


When Scott completes the care plan, Dr. Bodzin is thrilled he finally gets to present an “A” on his report card and deliver the good clinical news that he’s ready to transition to wellness care! Coupled with the good financial news Holly will share next, this once stressful process is now stress-free for Dr. Bodzin since patients, like Scott, have become accustomed to regular monthly payments.

Retention Principles: Forecasting Care and Feedback

Now, the time has come to deliver the great news to your patient that their original grade of a D is now an A! Imagine how great that will feel reporting this to your patient. Who doesn’t want to get an A? 

Now that you’ve presented the good clinical news, it’s time to deliver the good financial news. The danger ahead of your patient not transitioning to wellness care is more about the financial decision they have to make than anything else. The higher the financial hurdle, the more likely you’ll get the dreaded, “Let me think about it.”


Holly has prepared a new care plan based on Dr. Bodzin’s new treatment plan. She gets to deliver the good financial news that Scott’s monthly payments will be less! He’s thrilled and says “Yes!” to continuing care with the new program.

Retention Principle: Forecasting Care

Imagine how your patient will respond to the tremendous financial news that their monthly payment will go down! They get to transition to the next care plan and spend less money doing it. It makes it easy for your patient to stick with it and avoids the danger ahead of them not committing.


In one simple step, Holly collects Scott’s payment, schedules his monthly auto-debit, produces his copy of the plan, captures his electronic signature, and assigns him a wellness education email campaign. Scott is now enrolled in lifetime wellness care, never needing to be asked about money again!

Retention Principles: Forecasting Care, Frictionless Payments, and Frequent Contact

Your assistant will enroll your patient into their next care program in this step. The good news is? You’ve already done this before when your patient was first enrolled into their initial care plan, and the critical difference here is that the terms of the care plan are month-to-month and will go on indefinitely!

With this accomplished, you can simply take care of your patients without the worry of having to re-enroll them periodically. Not to say things can’t change or that they won’t ever need more or less care, but for their ongoing wellness or maintenance care, they’re good to go!

This is a critical step in the Loyal Patient JourneyTM. Once you’ve successfully transitioned more patients onto this indefinite care plan, you will eventually build a high retention practice and accomplish the success and joy you desire.


Scott is happy, feeling better, and tells Dr. Bodzin and Holly that he would love to purchase gift cards for referring family and friends! He’s now a loyal patient and will continue to be managed with all of the systems.

Retention Principles: Feedback, Forecasting Care, Frictionless Payments, and Feedback

Can you envision how great it will feel when you have most of your patients complete and your practice full of loyal patients?

How will it feel to get better clinical results because your patients followed through consistently? How will it feel to have recurring revenue you can count on? How will it feel to not worry about where your next new patient is coming from?

It felt incredible when I finally started having patients follow through and get great results. Having consistent monthly cash flow completely changed my life. Not worrying about where my next new patient was coming from was a game-changer. Once I utilized systems that implemented these four principles, it allowed me to have the freedom and success that I always dreamt of, and quite frankly, I want that for you as well. 

We’re on a mission in this profession to save lives. It’s hard to do that when patients drop out of care. When we have more and more patients staying under care and getting results, and becoming loyal patients…..practice is fun and rewarding!



About the Author

Holly Jensen has served the chiropractic profession since 2002 as a CA and Office Manager where she oversaw the operations of Dr. Miles Bodzin’s Chiropractic Wellness Center in San Diego, CA. For more than a decade she has continued to serve the chiropractic community as a Professional Speaker and the Chief Operations Officer for Cash Practice® Systems, the software & training company founded by Dr. Bodzin. To date, she has trained thousands of DC’s and CA’s on how to successfully attract, enroll and retain more patients while skyrocketing cash collections.  Holly may be booked for interviews and speaking engagements at or reached directly at Her inspiring story can be watched at

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