What's your true patient lifetime value?

Dental: $3,000-$8,000 LTV (5-7 yr retention, $400-$800/yr). Medspa: $2,500-$6,000 (3-5 yr, $800-$1,500/yr). Chiropractic: $3,500-$7,500 (4-6 yr, $700-$1,200/yr). Plastic surgery: $8,000-$25,000 (one-time + maintenance). Below these = retention problem.

3:1 is the baseline. Below 1:1 = unprofitable, kill the channel. 1-3:1 = working but not profitable enough to scale. 3-5:1 = healthy. Above 5:1 = under-investing in acquisition, could grow faster.

Pull last 5 years of patient records from your PMS. Count patients who had at least 1 visit each year. Average across cohort = your retention years. Most owners overestimate because they remember loyal patients, not the silent churners.

Months until your CAC is recovered from gross margin. Healthy: 6-12 months. Above 18 months = cash flow problem. Below 6 months = you can scale aggressively.

Yes — referrals are part of LTV. A patient who refers 2 friends has effective LTV = personal LTV + (referred LTV × 2 × close rate). The calculator doesn't auto-do this but you can multiply your LTV result by 1.3-1.5 to account for referral compounding.

5% retention lift = 25-95% profit lift (industry meta-analysis). Acquisition is linear (each new patient = +1 LTV). Retention is compounding (each retained patient × 1 extra year = +1 LTV without ad spend). Most service businesses spend 80% on acquisition vs 20% on retention. Flip it.

Six levers: appointment reminders cut no-shows (more visits), post-treatment follow-up (more rebooks), birthday flows (loyalty), reactivation flows (recover dormant), referral asks (compound LTV), review velocity (compound trust + new patients). Combined: +15-30% LTV in 90 days.

Estimate: monthly marketing spend (all channels) ÷ new patients per month. If you don't track new patients per month, that's the first thing to fix. Set up GA4 + Calendly attribution + UTM Builder (one of my other free tools) and track for 30 days before deciding what to scale.

Yes — adjust retention years (fitness 2-3 yr typical) and visits/year (10-12 for fitness). LTV math is the same. The vertical preset just loads industry-typical numbers as starting points.

Mandeep Singh, Sprout Sage Solutions. I run marketing automation for service businesses. LTV math is the foundation of every retainer engagement I take — if the unit economics don't work, no marketing budget fixes that.