What are the key components of a high performance Google Ads campaign?

I have been running Google Ads campaigns for 23 years, and I've been auditing accounts for the past 16 years. When I take over a Google Ads account I am routinely shocked at the terrible quality of campaigns and settings I find. I hope to set the record straight about what every Google Ads campaign needs. This isn't specific to Medical Aesthetic, it can be applied to almost every lead-gen focused business in existence.

1. Geographic Targeting: Target an appropriate radius, EXCLUDE nearby areas you wish to avoid, EXCLUDE every other U.S. state
2. Keyword Selection: Find keywords that work. Google's keywords recommendations are misleading and will waste money.
3. Negative Keywords: We have lists of negatives for every service. You should be going through twice-monthly to add negatives to avoid garbage traffic
4. Ad Assets (formerly "ad extensions"): Sitelinks, callouts, call assets, promotion assets and structured snippets should all be built out as fully as possible. Google allows up to 20 sitelinks, 20 callouts, 20 structured snippets and 20 promotion assets per campaign, plus a single price asset. One gotcha worth knowing: a paused sitelink still occupies one of those 20 slots, so you have to remove the link — not just pause it — to make room for a new one.
5. Ad Copy: At least 2 RSAs (responsive search ads) per ad group. Google caps you at 3 enabled RSAs per ad group, and only enabled ads count toward that cap, so pausing an old ad frees up a slot rather than forcing you to delete it. Ad copy should be interesting, unique, competitive, and enhance the brand behind it.
6. Conversion tracking: Form submissions, phone calls, live chat starts, and text message starts should all be tracked! Which brings us to the next topic:
7. Bidding: Automated bidding is only useful if you are feeding good conversion data to the campaign. If you have 50+ conversions per month, you should test automated bidding. If you have less than 50 conversions per month, you do not have enough data for automated bidding to be effective in many cases!
8. Integration: Integrating with Google Analytics plus 3rd party tracking platforms like CallRail will give you even more data and insight to help optimize campaigns (pages per visit, time on site, pages viewed, first time caller or not, and call duration)