Google "Hosted" Conversions & Conversion Help - Need Advice.

I started running some google ad campaigns for friends of mine. Some of them are doing really well but two i particular are not.

My one friend is spending about $1000 a month and only getting 17 conversions. My goal is to get an average about 30 per month - but we've been stuck at this conversion rate for a a few months now. I've been making changes on the website to try to improve conversions but rate stays nearly the same. Sometimes ill get 20ish, sometimes ill get 15ish.

Anyway, I installed gtag and have tel:, email (she has her email on there), and form tracking running. She's a doctor so she mainly wants to book new patients. Currently I'm just sending them to her main site for generic terms (foot doctor near me) but more specific ones i'm sending to service pages (custom orthotics near me goes to the orthotics page for example). I did some optimization on the pages -- tried to clean up the text/formatting and add a few more CTAs but still conversions remain roughly the same.

This whole time I've been mostly watching the conversions on the main page & on the charts. But today I went to check something with the goals and noticed a bunch of new "google hosted" goals have been added and set as primary conversions.

Local Actions Directions/website visits/etc

The one thing that threw me off was the one goal "Clicks To Call" has 19 all conv. Where as my gtag tracking clicks only has 6. "Calls from ads" has 4 and "bookings" has 5. Then I have a "email" click one with 2.

What are these google hosted conversions? Is my campaign taking them into account? Should I remove them? Why did they randomly generate on this campaign? Are they coming from people clicking my ad and I should tell her that these are conversions from the campaign?

I'm really confused. The other question I have is Sitekit is now asking to connect to an ads account. Is this worth doing if I already have gtag actions setup? Is Sitekit more/less accurate?

I'm also wondering if there are any improvements I can make to the conversion tracking that I'm missing.

Thanks

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