A patient in Chula Vista opens Google, types "best place near me for lip filler that does a consult first," and gets one paragraph naming three clinics. She books with one of them. Her phone never showed her ten blue links, and she never scrolled past the answer. Whether your clinic was one of those three came down to a process almost nobody running a clinic has seen described.
How the shortlist gets built
Google spells out the mechanics in its own developer documentation, and the plain version is short. When someone asks AI Mode a question, Google splits that one question into many searches across subtopics, a technique it calls query fan-out, then assembles an answer from what comes back. Google states there are "no additional requirements to appear in AI Overviews or AI Mode, nor other special optimizations necessary," and adds that "you don't need to create new machine readable files, AI text files, or markup." Anyone selling you a special file to feed the robots is selling you something Google says does nothing.
SOCi, a company that sells local marketing software to multi-location brands, ran 3.2 million queries through ChatGPT, Gemini and Perplexity across 2,751 brands and roughly 350,000 locations, and published the results in January. Those businesses appeared in Google's local three-pack 35.9% of the time on average. ChatGPT recommended 1.2% of the same locations, Gemini 11%, Perplexity 7.4%. Read the vendor's incentives into the numbers if you like, since SOCi sells the fix. The direction holds regardless.
The assistant hands back three names, and there is no second page for the fourth.
Ratings work as a gate rather than a tiebreaker. In SOCi's data, locations ChatGPT recommended averaged 4.3 stars, Perplexity 4.2, Gemini 3.9, and SOCi's healthcare write-up in September put it flatly: below roughly four stars, many AI systems filter a location out of consideration entirely. BrightLocal surveyed 1,002 US adults in February and found 31% will only use a business rated 4.5 or higher, up from 17% the year before, and that 74% weight reviews from the last three months most heavily. A dental practice sitting at 4.6 stars with nothing newer than 2024 is in worse shape than its average suggests.
What changed in 2026
At I/O in May, Google said AI Mode had passed one billion monthly users a year after launch, with queries more than doubling every quarter. The shape of those queries moved too. Google reported the average AI Mode search runs triple the length of a traditional query, that planning questions grew 80% faster than AI Mode queries overall across six months, and that more searches now open with "where to" and "where should I." People are describing a situation and asking for a recommendation, which is the moment a clinic or a brokerage wants to exist.
The bigger change is that the assistant started acting. Google announced it is expanding agentic booking in Search to "local experiences and services," including AI that phones businesses in home repair, beauty and pet care, rolling out to everyone in the US over the summer. Google has been calling businesses for pricing since July 2025 through a "Have AI check pricing" option, with participation governed in Business Profile settings. The 2026 version books. For a med spa, that means an unfamiliar voice asking your front desk about Thursday availability on a specific service, and whatever your receptionist says becomes the comparison a prospect reads.
How sources appear changed as well. In late May, Google expanded Preferred Sources into AI Overviews and AI Mode, letting people nominate sites they want to see more often, and reported more than 345,000 unique sources already chosen and that people are twice as likely to click through to one. Google added a Perspectives carousel surfacing "helpful perspectives from online discussions, forums, and social media," and a Highly Cited label marking original reporting that other coverage references. Forum threads and social posts about your practice now have a labelled slot in the interface.
Other people's websites decide this
Four researchers at the University of Toronto ran 1,000 consumer ranking prompts across ten categories through ChatGPT, Perplexity, Gemini and Claude, then compared the sources against Google's. Their September 2025 paper found the AI engines lean hard on earned media, meaning third-party coverage, over anything a brand publishes about itself. In US consumer electronics, 92.1% of the sources the AI engines used were earned. In Canadian automotive, the AI split was 69.1% earned and 30.9% brand-owned with no social results, against Google's 40.6% earned, 36.6% brand and 22.8% social. Overlap between what the AI engines cited and what Google ranked stayed low, running from 0.1% in IT support to 20.6% in home cleaning among local service categories.
Your own website is the asset you control and the one these systems weight least. Corroboration carries the load: the same facts about your business, spelled the same way, showing up on Google Business Profile, on Yelp, in the directories your category lives in, and in writing other people did. For a dental group that means the health directories patients browse. For a Tijuana clinic serving US patients it means the review threads and forum posts where people compare providers across the border. When those sources disagree about your address, your hours or what you treat, the assistant treats the conflict as risk and names a competitor it can verify.
The unglamorous list
None of this rewards cleverness, and most of it is front-desk work rather than marketing work.
- Make your name, address, phone and service list identical everywhere they appear, starting with Google Business Profile and the two or three platforms your category depends on.
- Ask for reviews continuously rather than in an annual push. Recency carries weight, and BrightLocal found 47% of consumers skip a business with fewer than 20 reviews.
- Reply to the reviews you get. SOCi measured the average business answering 46.9% of its Google reviews, taking 4.3 days to do it.
- Write plain answers to the questions patients and buyers ask out loud, in their words, including price ranges and what a first visit involves.
- Brief whoever answers your phone, because sometime this year the caller asking about Thursday may be Google.
Questions are welcome: hola@xala.studio