I had a plastic surgeon tell me last week that he’s paid the same SEO guy for years. He ranks on Google. Looks great. But when a patient asks ChatGPT for the best surgeon in their city, his name never comes up. AI has a verdict on his practice, and by that verdict he barely exists. He had no idea, because until recently there was no way to look.
You are probably in the same spot without knowing it. You run paid ads, Google and maybe Meta. You have someone you trust handling your SEO. You assume that covers you. For years it did. Getting to page one of Google was the whole job.
That job split in two, and most practices only know about half of it. Your patients don’t only Google you now. A lot of them open ChatGPT or Perplexity and just ask. Who’s the best injector near me. Where should I get Botox. Who does the best facelifts in this city. The assistant comes back with a name, sometimes two. Not a page of links to sort through. One answer. And ranking on page one of Google does not put you in that answer. These are two different systems reading two different sets of signals. I’ve started calling it the second search box, because that’s what it is. A new place your patients look, and you’re probably not in it.
This isn’t a hunch. A 2026 analysis of 350,000 locations found only about 1 percent get recommended by ChatGPT, while 36 percent show up in Google’s local three-pack. Strong Google rankings and AI recommendations are close to separate games. And the share of people using AI to find a local business went from roughly 6 percent last year to 45 percent this year. The behavior moved fast. The ranking you paid for didn’t follow it.
This is where most tools either overpromise or make it complicated. The reason I keep pointing people to Local AI Registry is that it works both sides, and it’s honest about what it can and can’t promise.
Start with the free part. You type in your practice and it gives you an AI Score from 0 to 100, tells you which assistants actually name you, and explains in plain English why. No card, nothing to buy to see it. The score is built on eight signals, weighted by how much each one actually moves an AI recommendation. This part is worth screenshotting, because it doubles as the checklist for what gets you named:
- Retrieval grounding, 26%. Whether AI can pull you up and cite you at all. The heaviest signal, and everything else feeds it.
- Off-property attestation, 20%. What other sites say about you: mentions, videos, the best-of lists AI leans on.
- AI visibility, 14%. Whether ChatGPT, Gemini and Perplexity name you when asked, and for the right service.
- Reviews and response, 12%. Not your star average. How many, how recent, and how specific, because AI quotes specifics.
- Backlink and citation authority, 8%. The links and citations across the web that vouch for you.
- Google Business Profile, 8%. Whether yours is complete, accurate and current.
- Speed and mobile, 7%. Whether your site is genuinely fast and works on a phone.
- Content freshness and schema, 5%. Whether your pages stay fresh and machine-readable.
Look at the top two. Retrieval grounding and off-property attestation are 46 percent of the score between them, nearly half, and neither one is something a Google ranking buys you. Here’s why. When a patient asks for the best med spa near them, the assistant quietly splits that into a dozen smaller questions and builds an answer out of your Google profile, your Yelp page, a local best-of list, a YouTube review, a news mention. If those sources don’t line up and back you, you don’t get named. Page one of Google barely touches that. It’s the whole reason the ranking you already pay for doesn’t carry into AI.
So here’s what Local AI Registry actually does about it. It runs in four tiers, and you can start free and move up only if you want to.
Get Listed is free. It puts you in the registry so AI can confirm you exist: your name, location, hours and services, written the way these systems read them. It also shows you the real questions patients in your city are asking AI, and where you’re invisible right now.
Get Found makes your information correct and identical everywhere AI looks, so you start showing up when someone asks who the injectors in your area are.
Get Recommended manages your Google Business Profile and your reviews for you, replies to them in your voice, and gets you mentioned on the sites AI already trusts, so AI starts naming you when a patient asks who to see.
Own Your Market rebuilds the parts of your site AI actually reads, the structure, the schema, the content, so you become the default answer when someone asks who’s the best.
A few things that make it simple. It’s month to month, and you can move up or down between tiers whenever you want. And you don’t have to do any of it yourself. You can hand it to whoever manages your website, or run it from one dashboard. You decide how involved you are.
So start with the free look. Type in your practice, see your AI Score, and see what AI is already saying about you. Then decide how far you want to take it.
Look up your practice: localairegistry.com