Performance Max in Google Ads: A 2026 Guide for Clinics

What Performance Max is

Google describes Performance Max as a goal-based campaign type that reaches all Google Ads inventory from one campaign. You supply four things:

• A goal. Leads, sales, website traffic, or local store visits. Clinics almost always pick leads, with conversions such as booked appointments, calls and WhatsApp clicks.
• Assets. Headlines, descriptions, images, logos and videos, grouped into asset groups.
• Signals. Search themes and audience signals that hint at who to reach. They guide the AI but do not limit it.
• A budget and bid strategy. Maximize conversions or conversion value, with an optional target CPA or ROAS. See our guide to Smart Bidding.

Google then decides where each ad shows, which assets to combine and how much to bid. You get less control than in a Search campaign, and in return you get reach on channels a Search campaign can't touch.

How PMax competes with your Search campaigns

Most clinics run PMax next to Search, so it matters which one wins a given search. Google's keyword prioritisation rules work like this:

1. An exact match keyword identical to the search wins over phrase and broad keywords and over PMax.
2. Phrase and broad keywords share the same priority as identical PMax search themes.
3. When two options tie, the one with the higher Ad Rank serves.

In practice: if [dermatologist dubai marina] is an exact keyword in your Search campaign, that keyword should take that exact search. Close but different searches, such as "skin doctor near JBR", can go to either campaign. AI Max for Search follows a similar rule against PMax: when a query is eligible for both, the higher Ad Rank serves.

Healthcare limits that change how PMax works for clinics

PMax was built for advertisers who can use every signal. Health advertisers can't. These are the rules that bite.

The practical effect: your PMax signals are mostly search themes, your landing pages and Google's own audiences. Your conversion data does most of the steering. If that data is weak, PMax has little to work with. Fix conversion tracking first.

Should your clinic use Performance Max?

A common good fit is a multi-branch dental group in Dubai and Abu Dhabi with solid booking data. A common bad fit is a new single-doctor clinic in Al Barsha that can't yet tell a real lead from a job seeker. For more on that problem, read why Google Ads brings bad-quality leads.

Setting up asset groups for a clinic

An asset group is a set of creative built around one theme, with one final URL. For clinics, the clean structure is one asset group per service line, each pointing to that service's page. A Dubai dermatology clinic might run "Acne treatment", "Laser hair removal" and "Skin check-up" as separate asset groups.

Google's asset specifications:

Write every headline as if a DHA inspector will read it. Avoid "best", "guaranteed" and drug names. Use real photos of your clinic and staff, not stock images of perfect skin. If you turn on text customisation, check the generated assets in the asset report each week. Remove anything you wouldn't sign off yourself.

Search themes

Search themes tell PMax which searches matter to you. You can add up to 50 per asset group. They carry the same priority as phrase and broad match keywords in Search campaigns. Your exclusions and negative keywords still apply.

For a "Laser hair removal" asset group, themes could include "laser hair removal dubai", "full body laser hair removal" and "laser hair removal for men". Skip near-synonyms that reach the same people. Google's own advice is not to add both "car" and "automobile". If a theme duplicates an exact keyword in your Search campaign, the Search keyword wins that search anyway.

Brand exclusions, negative keywords and URL controls

Brand exclusions

Brand exclusions stop PMax from serving on branded searches. In PMax they cover Search, Shopping and YouTube search inventory. Use them for two jobs:

• Protect your brand campaign. Without exclusions, PMax often picks up searches for your own clinic name. These are cheap conversions you'd get anyway, and they make PMax look better than it is. Exclude your own brand and run brand terms in a Search campaign you control.
• Stay off other brands. Exclude large hospital groups or competitors whose patients you don't want to pay for.

Account limits allow 10 brand lists per campaign and 5,000 brands per list. If your clinic name isn't available as a brand, add it as a phrase match negative keyword instead.

Negative keywords

Since early 2025, PMax supports campaign-level negative keywords, up to 10,000 per campaign. They apply to Search and Shopping inventory only, not YouTube or Display. Account-level negatives also apply. Clinics should block job, course, licensing and DIY searches from day one. Our negative keywords guide has a ready-made healthcare list.

Final URL expansion and URL exclusions

With final URL expansion on, Google can send people to any page on your domain. For a clinic, that can mean the careers page, an old blog post or a page that names prescription drugs. Either switch expansion off, or add URL exclusions for careers, blog, pricing and policy pages. You remain responsible for every landing page Google picks.

Reporting in 2026: what you can now see

PMax used to be a black box. That has changed a lot since 2025:

• Channel performance report. Announced in April 2025. Shows how each channel, such as Search, YouTube, Display and Maps, contributes to your goals, with a downloadable table of clicks, conversions and cost.
• Search terms report. Rolling out since April 2025 at the same detail as Search campaigns. Use it to find wasted queries and add negatives.
• Asset reporting. Impressions, clicks, cost and conversions per asset, not just a "Low/Good/Best" label.
• Asset group segments and search theme insights. Device and time breakdowns, plus a column showing whether a query came from a search theme or from keywordless matching.
• Channel prioritisation. Google announced on 14 October 2026 that you can mark channels as High or Low priority and cap Low priority spend. It is rolling out over the coming months. See our news write-up.

A weekly 20-minute check for a clinic: open channel performance and see where the money went. Scan search terms for jobs, courses and other wasted queries. Pause weak or non-compliant assets. Compare cost per booked appointment, not cost per form fill, with your Search campaigns.

Common PMax mistakes clinics make

• Launching PMax before tracking separates real bookings from spam forms.
• Letting PMax take branded searches, then crediting it with patients who would have booked anyway.
• One asset group for every service, so ads for fillers land on the dental page.
• Leaving final URL expansion on with a careers page live.
• Judging PMax in its first two weeks. Smart Bidding needs time and conversion data to settle.
• Starving it of budget. Google shows Low, Medium and High budget suggestions when you set up; the Low one is its minimum recommendation.

Clinic owners who want a second opinion on their PMax setup can ask Access One to look at it.

Frequently asked questions

Is Performance Max good for clinics?

It can be, once a Search campaign is working and conversion tracking counts real bookings. It adds reach on YouTube, Maps and Display. Clinics without reliable conversion data should start with Search.

Can I use remarketing lists in Performance Max for my clinic?

Usually not. Google's health in personalised advertising policy blocks Customer Match, your data segments, lookalikes and audience expansion for ads about health conditions, treatments and procedures. Predefined Google audiences and search themes are still available.

Can I see search terms in Performance Max?

Yes. Since 2025, Google has been rolling out a search terms report for PMax at the same detail as Search campaigns. Use it to add campaign-level negative keywords, up to 10,000 per campaign.

Does Performance Max take traffic from my Search campaigns?

It can. An exact match keyword identical to the search takes priority over PMax. For phrase and broad keywords, priority is shared with PMax search themes and the higher Ad Rank wins. Brand exclusions stop PMax taking your brand searches.

How many search themes can I add?

Up to 50 per asset group. They count as the same priority as phrase and broad match keywords, and negative keywords still apply to them.

Do I need a video for Performance Max?

Google recommends at least one video longer than 10 seconds. If you don't add one, Google may generate one from your images and text. For a medical brand, it's better to upload a short real video of your clinic.

Sources

• Google Ads Help: About Performance Max campaigns
• Google Ads Help: How asset groups work
• Google Ads Help: Use search themes with your Performance Max campaign
• Google Ads Help: Apply brand exclusions to Performance Max or Search campaigns
• Google Ads Help: Negative keywords in Performance Max campaigns
• Google Ads Help: More goals and image controls coming to Performance Max
• Google Ads Help: About keyword matching options
• Google Ads Help: About your Google Ads account limits
• Google Ads Help: About audience signals for Performance Max
• Google Ads Policies: Health in personalised advertising
• Google Ads Policies: Update to restricted drug terms (October 2025)
• Google Ads Policies: Healthcare and medicines
• Google Ads blog: New Performance Max features (January 2025)
• Google Ads blog: Channel performance reporting in Performance Max (April 2025)
• DHA: Standards for Medical Advertisement Content on Social Media

Published 18 Oct 2026 · Access One