Reviews do two things nothing else in your marketing does. They contribute to how prominently your practice appears in local search, and they are what a person reads immediately before deciding to call you. A practice with a strong, current review profile converts more of the traffic it already has, which is why this lesson comes before the one about buying traffic.
Reviews are also the area where dental practices most often break a rule without realizing it, in two directions: how the reviews are obtained, and what gets said in the reply. Both have real consequences, and both are avoidable with a written system.
What you will learn
- What the FTC rule and platform policies actually prohibit, stated plainly.
- Why review gating is off the table, and what to do instead.
- How to design a review request that is compliant, neutral, and effective.
- How to reply to any review without disclosing that someone is a patient.
- A decision table for negative, unfair, and fake reviews.
- How to build patient and professional referrals, and where the legal limits sit.
This lesson explains rules in plain language. It is not legal advice. Confirm your obligations with your own attorney, your state dental board's advertising rules, and your compliance advisor before changing your review or referral process.
The rules, stated plainly
The FTC rule
The Federal Trade Commission's Rule on the Use of Consumer Reviews and Testimonials took effect on October 21, 2024, and courts may impose civil penalties for knowing violations. In summary, it prohibits:
- Fake reviews and testimonials, including reviews written by people who never had the experience, and buying or selling them.
- Reviews bought with compensation conditioned on the sentiment expressed. Paying, discounting, or giving anything of value in exchange for a positive review is prohibited.
- Undisclosed insider reviews. Reviews by owners, employees, or their immediate relatives without clearly disclosing the relationship.
- Review suppression through threats, intimidation, or false legal accusations to force removal of a negative review.
- Misrepresenting an independent review site that the business actually controls.
- Buying fake followers or engagement metrics.
What the rule does permit matters just as much: a business may ask its customers for reviews through generalized requests. The FTC's guidance is clear that emailing recent customers and asking them to share their experience is fine. The line is sentiment. An incentive offered only for a positive review, or an ask directed only at people you expect to be happy, is the problem.
Platform policies
Google's policy on incentivized or biased reviews defines an incentivized review as one influenced by a payment, discount, free goods or services, or any other benefit offered to the reviewer, or biased by a personal or professional conflict of interest, and states that offering incentives in exchange for reviews undermines content integrity and can mislead consumers. Platforms remove reviews they identify as incentivized and can penalize the business, which means an incentive scheme can destroy the review profile you already earned.
Your state dental board
Many state dental practice acts regulate testimonials in dental advertising, and some restrict or condition their use. If you plan to feature reviews or testimonials on your website or in ads, check your board's advertising rules first. Our state resource pages link to the boards.
Review gating, and why it is off the table
Review gating is the practice of surveying patients first and then directing only the satisfied ones to a public review site while routing unhappy ones to a private feedback form. It is common, several software vendors have sold it, and it is not a defensible practice: it produces a review profile that misrepresents the real distribution of patient experience, and it conflicts with platform policies against biased reviews.
What you do instead is simple. Ask everyone, the same way, and route nobody. If a patient wants to say something critical, they are going to say it either way, and a practice that responds well to criticism in public often converts better than one with an implausible wall of five-star reviews.
A review profile with a small number of critical reviews and thoughtful public responses reads as authentic. A profile with hundreds of reviews and no criticism reads as purchased, and many patients now recognize the pattern.
Designing a compliant ask that still works
Compliant does not mean ineffective. Three variables determine whether patients actually leave reviews: who asks, when, and how easy the next step is.
| Variable | What works | What to avoid |
|---|---|---|
| Who asks | The person the patient built rapport with, usually the hygienist or assistant, reinforced at checkout | A generic automated message with no human context |
| When | At the end of a positive visit, with a follow-up link sent within a few hours | Days later, when the visit is forgotten |
| How | A text or email with a direct link that opens the review form in one tap | Asking people to search for you, or a link that requires several steps |
| Who is asked | Everyone, on a consistent rule, such as every completed new patient visit and every hygiene visit | Only patients you predict will be positive |
| Incentive | None, ever | Raffles, discounts, gift cards, or office contests tied to reviews |
The ask, as prose
Chairside, from the hygienist: "If you have a minute sometime, an honest review helps other people in the neighborhood find us. I will have the front desk send you a link, and either way it was good to see you today." That is compliant because it asks for an honest review, not a positive one, and offers nothing in return.
At checkout: "Sarah mentioned sending you a review link. I will text it to this number in a few minutes. No pressure at all, and thank you for coming in."
The follow-up text: "Thanks for visiting us today. If you have a moment, we would appreciate an honest review: [link]. If anything did not go well, please call us at [number] so we can fix it."
That last line is worth keeping. It is not gating, because it does not route anyone away from the review site or condition the link on satisfaction. It is an invitation to talk to you as well, which is what a good practice would offer regardless.
The expensive mistake: a staff contest or bonus tied to the number of five-star reviews collected. It creates exactly the incentive the FTC rule prohibits, pressures staff toward selective asking, and risks the platform removing the reviews. If you want to reward the team for reviews, tie any recognition to asking consistently, not to the ratings received.
Replying without violating HIPAA
Here is the part practices get wrong most often. Confirming that a reviewer is a patient is itself a disclosure of protected health information. So is correcting their account of their treatment, mentioning what procedure they had, what they were charged, or when they were seen, even when the reviewer disclosed it first and even when you are right.
The HHS Office for Civil Rights has settled enforcement actions with dental practices over exactly this. New Vision Dental paid $23,000 in December 2022 in a matter involving disclosure of patient information in responses to online reviews, and Elite Dental Associates paid $10,000 in 2019 over social media disclosures of patient information. A patient publicly discussing their own care does not waive your obligations.
Rules for every reply
- Never confirm or deny that the reviewer is a patient.
- Never mention any treatment, diagnosis, appointment, balance, or date.
- Never correct the facts of a specific case in public, however wrong the review is.
- Keep the reply short, courteous, and general.
- Move the conversation offline with a phone number and a name.
- Have one trained person write all replies, using approved language.
- Reply to positive reviews too, and keep those equally general.
Templates that stay general
For a positive review: "Thank you for the kind words. We appreciate you taking the time, and we will share this with the team." Nothing more. Do not add "we are so glad your crown went well."
For a negative review: "Thank you for the feedback. We take all concerns seriously and would like the chance to discuss this. Please call our office manager, Dana, at [number]." That reply says nothing about anyone's care and shows every future reader that the practice responds like adults.
For a review that appears to be about a different office or is clearly not a patient: reply with the same general language or do not reply at all, and use the platform's reporting process. Do not say "you were never a patient here."
Write your three approved replies once, keep them in the systems binder, and let one person use them. Practices get into trouble when an upset owner replies at 11pm. Build a rule: nobody replies to a negative review on the day they read it.
The negative review playbook
| Situation | What to do | What not to do |
|---|---|---|
| Legitimate complaint about service (wait time, billing confusion, front desk tone) | Reply generally, invite a call, then actually fix the underlying process | Explain or justify in public |
| Complaint about clinical outcome | General reply inviting a call; involve your malpractice carrier if it suggests a claim | Discuss the treatment in any way |
| Factually wrong review | General reply; offer to discuss offline | Correct the facts publicly, which discloses that they are a patient |
| Review that violates platform policy (off topic, harassment, conflict of interest, spam) | Report it through the platform's process and document the report | Threaten legal action to force removal, which the FTC rule addresses directly |
| A cluster of negative reviews in a short period | Look for the operational cause first, because there usually is one | Assume it is a competitor attack |
Fake and abusive reviews do happen, and reporting is the remedy. It does not always work, and the most reliable defense is a steady flow of real reviews, which pushes any one bad review down and dilutes its effect on your average.
Patient referrals
Referred patients arrive pre-trusted, accept treatment at higher rates, and cost nothing to acquire. Most practices get fewer than they could because they never ask and never make it easy.
- Ask at the right moment, which is when a patient expresses satisfaction, not on a poster in the waiting room. As prose: "If you have friends or family looking for a dentist, we would be glad to see them. We are taking new patients."
- Make it easy to pass along. A card with the phone number and website, or a text you can send that they can forward.
- Close the loop. When a referred patient arrives, thank the referrer with a handwritten note. A note is not compensation and is never conditioned on anything.
- Track it. The referral source field from Lesson 6 is how you find out that referrals are your largest channel, which they often are.
Rewards for referrals are a legal question, not a marketing question. Offering money, gift cards, or discounts to patients for referring others can implicate federal and state health care fraud and abuse laws, and the analysis differs depending on whether federal health care program business is involved. State dental practice acts may also restrict fee splitting and inducements. Do not adopt a referral reward program because another office has one. Ask your own health care attorney first, and get the answer in writing.
Professional referrals
Referrals between practices are relationships, not campaigns. Two that pay off for general dentists: specialists you refer to, who often refer general work back, and local physicians, pediatricians, and other health professionals whose patients ask them for a dentist.
What works is unglamorous. Send a clear referral letter with the reason for referral and the imaging. Report back after treatment. Meet the specialist in person once. Be the office that is easy to reach and quick to reply. Keep any arrangement free of anything of value flowing in either direction for referrals, for the reasons in the callout above.
Building the system
Write one page: who asks, when, what they say, who sends the link, who replies to reviews, and what the approved replies are. Then track two numbers monthly: new reviews received and the number of patients asked. If reviews are low and asks are high, the ask or the link is the problem. If asks are low, it is a habit problem, and it belongs in the daily huddle.
Next, Lesson 5 covers paid ads without waste. Read alongside this lesson: the marketing chapter, the Google Business Profile guide, and the compliance chapter.
Try it
- Audit how you currently get reviews. Write down exactly who asks, when, what is said, and whether anyone is filtered or offered anything. Compare it against the FTC and platform rules in this lesson. Stop anything that does not survive the comparison, today.
- Write the three approved replies. Positive, negative, and unclear. Keep them general, under three sentences, and name a person and a number to call. Put them in the systems binder and tell the team that only one person posts replies.
- Reply to every unanswered review. Work backward twelve months. Keep every reply general. Note how many were unanswered, because that number is usually surprising.
- Test the review link yourself. Send the link to your own phone and count the taps to a submitted review. If it is more than about three, fix the link before asking anyone else.
- Script the referral ask and use it ten times. One sentence, at the moment a patient says something positive. Count how many referred patients arrive in the following two months.
- Check your state board's advertising rules on testimonials. Read the actual rule text, not a summary, before putting any review or testimonial on your website.
Check yourself
1. May a dental practice ask patients for reviews?
Yes. The FTC rule permits generalized requests to customers to share their experience. What it prohibits is fake reviews, compensation conditioned on the sentiment expressed, undisclosed insider reviews, and suppressing negative reviews through threats. Ask everyone, ask for an honest review, and offer nothing.
2. What is review gating and why should a practice not do it?
Gating is surveying patients first and sending only the satisfied ones to a public review site. It produces a profile that misrepresents actual patient experience and conflicts with platform policies on biased reviews. Ask everyone the same way and route nobody.
3. A reviewer names their procedure and complains that it failed. May you correct them?
No. Confirming that they are a patient, naming the treatment, or correcting the facts publicly all disclose protected health information, and the patient disclosing it first does not waive your obligation. Reply with general language and invite a phone call. OCR has settled enforcement actions with dental practices over exactly this.
4. Why is a staff bonus for five-star reviews a problem?
It creates compensation tied to the sentiment of reviews, which is what the FTC rule prohibits, and it pressures staff into selective asking. Platforms also remove reviews they identify as incentivized. Recognize consistent asking instead, never the ratings received.
5. Can you pay patients for referring their friends?
That is a legal question to put to a health care attorney before doing anything. Rewards for referrals can implicate federal and state fraud and abuse laws, and state dental practice acts may restrict inducements and fee splitting. A handwritten thank-you note that is not promised in advance and is not conditioned on anything is a different thing entirely.
This guide is educational content and does not constitute legal, financial, tax, or clinical advice. Laws and regulations vary by state and change over time. Consult your own dental-specific attorney, CPA, and state dental board before acting.