So welcome, everyone, to our Q1 2025 presentation. As usual, it'll be me presenting, the CEO of Nordhealth; and my colleague Alex Cram, who's our CFO. We'll start with company updates, then we'll deep dive into the different business units, the veterinary business unit, then the therapy business units. Alex will go through financial updates, and we'll leave time for questions at the end. Please hold your questions till the end, and you can ask questions either on the chat or you can raise your hand to be able to ask questions in the latter part of the presentation. Starting with the company update. At the end of Q1 2025, our signed ARR stood at EUR 44.9 million, which entails a 21.5% organic ARR growth year -over -year.
The source of the growth was a net retention rate of 115.5%, which was higher than the previous in 2024, and also a churn rate of 4.6%, which is lower than the previous quarters. We also have been able to improve our EBITDA minus CapEx to negative EUR 1.1 million, which is an adjusted EBITDA minus CapEx margin of 2.4%. Looking historically, right, so we've had a 51% organic and acquisition net growth CAGR since 2018. You can see we've had a consistent history of growth as we have not, we always take a quite conservative approach with signed ARR, so it's only if there are current customers such as Vets4Pets or AmeriVet, which are piloting the software. We actually do not, we include the pilot clinics in that number, but we do not include post-pilot rollout ARR.
Looking at how we've been able to grow year- over- year, the first, let's start all the way at the left. At the end of Q1 2024, reported was EUR 34.7 million. Every year we reset the currencies to make sure that we use the December 31st currencies of the previous year. That had a negative impact, decreasing the Q1 2024 ARR by EUR 34.1 million, mostly due to the weakening of the NOK. That is our starting base for that we'll be comparing to. If we look at the source of growth, we were able to sign EUR 2 million of new ARR in the last 12 months, net upsell of EUR 6.9 million, and churn of negative EUR 1.6 million. That is how we break down the 21.5% year- over-year growth.
This 20.1% net upsell is primarily driven by this CVS implementation, and we also were able to have EUR 2.1 million of signed not implemented ARR, which is a reduction since last year as we've been able to successfully implement CVS clinics. We also have EUR 1.3 million of other businesses which are not veterinary and therapy related. If we look at the progression of CapEx, we mentioned that we had a goal to reach breakeven plus or minus EUR 2 million for the year. We can see that we've been consistently improving our profitability over the years with LTM Q1 2025 being EUR 1.1 million, so roughly on par with where it was before year 2024. Now diving into veterinary. From a business standpoint, we can reveal now that AmeriVet, which is a 200-plus location U.S. clinic chain, was the U.S. customer that we signed in 2024, and they're piloting this year.
We're really excited to have them as a partner in the U.S. as our first enterprise partner. We've also signed a second, but slightly smaller clinic chain called PetVet 365, which is a 35-location U.S. clinic chain in May 2025. In total, SME and enterprise ARR, we've been able to sign in new customers around EUR 900,000 of ARR in Q1 2025. We've also implemented 410 CVS locations as of the end of 2025, and we've got 89 left to implement. We've been able to acquire provet.com, which will be our future domain name. We'll be dropping the cloud at some point. Now breaking down how the growth has veterinary, we grew 33.2% year -over -year, which was driven EUR 1.2 million came from new customers.
Net upsell was EUR 5.8 million, mostly driven by CVS, as we mentioned, and our churn was negative EUR 0.6 million, which is a 3.4% churn, which is very, very good. We still have EUR 2.1 million of signed but not implemented. You can see that that has come down from EUR 3.5 million in Q1 2024. We introduced this new chart to provide some historical view of the main KPIs on the ARR side. You can see the historical growth from 2021 - LTM Q1 2025, which has been roughly 28.3% over this period of time. There are lots of ups and downs, as you can see, because of these enterprise contracts, which can be implemented in one year and then piloted another, but that has a big difference on ARR.
If we think about the sources of growth, one is new customer ARR, which again has been going up now, but it's around 8.3%. Then we have net upsell of 22.6% as our current customers are spending more with us or implementing more clinics, and we're selling net new products to them. We have a churn rate of negative 2.6%. That's probably the most unique number in the tech, this 2.6% data. Basically, a negative 2.6% means that they'll stay with us for decades if you look at it mathematically. The way you get net retention is basically the net upsell minus the churn rate. I want to divide those up too because I think it's good to highlight the churn rate, which is probably one of the most unique parts of our business.
Good to note that churn in 2024 was slightly higher, and that happens because we actually sunsetted two products. When we sunset products at the end of that period, when we turn off the software, some people decide not to move forward. You can see the impact of that in 2024 and LTM Q1 2025. Looking at profitability on the veterinary side, these figures are adjusted BU, EBITDA minus CapEx. They actually include all group allocations. It is a true view of profitability for the business units. We can see that LTM Q1 2021 was at negative EUR 2.4 million, so we have been able to consistently improve our profitability. The main drivers of the improvement in Q1 2025 versus 2024 have been one is growth, which is the biggest one, which had a EUR 1.5 million impact and recurring revenues. We had additional other revenues of around EUR 400,000.
However, we've had additional cost to be able to serve customers around EUR 600,000. And we've continued to invest in product development around EUR 400,000. Then there's other costs around EUR 300,000. That breaks down how we've been able to improve over time. Now, where does that growth come from? And let's focus this time on 2021 versus 2024. We can see we've had growth in the U.K. as a result of being able to successfully implement CVS, but also implementing other clinics. Secondly, we've had some nice growth as well in Southern Europe, where in Spain, Portugal, we've had customers implement our software. You can see as well that we've had continued success in the Nordics, which has grown quite nicely in Q1 2025.
Looking at a different cut of the data, same data, we can see that a big part of our growth is actually coming from the majority of our growth is coming from enterprise. We have EUR 0.9 million coming from enterprise and EUR 0.4 million coming from SME customers, which are independents. One thing that is really important to note is that despite our focus on enterprise, our customer concentration remains low, with our top three customers composing around 22% of our ARR. Now, looking at the migration, which is one of our other big goals as our strategy is to grow organically, but also by acquisition and migration. We have been able to successfully migrate from 2023, which was EUR 7.9 million, a lot of our customers over to our flagship product, Provet.
What we can see is that the cloud share of AR has increased from 40% in 2021 to 78% in 2025 Q1. This is a really important goal for us because if we migrate people on our customers onto the new platform, we have much better opportunity to upsell, much better data security. We have a plethora of benefits, including not having to maintain two different softwares. We are currently working on the migration of Sanimalis in Norway and also the migration of VetVision in Denmark. Now, looking at therapy. On the therapy side, the main focus of this year is migration of Aspit customers to the Unified Platform. We are able to migrate 160 Aspict users to the Unified Platform with only one user churning. The roll-out continues at a measured pace, so we can act on early feedback.
Our approach to this is implement a certain specific user segment, wait till they're happy. Once they're happy, we roll- out the full user segment, and then we go segment by segments. You can think of segments as like private psychologists or public psychologists and then private physiotherapists and so on. They've got different feature requirements, and we try to target them very specifically. We are being careful with migration as it's a very small market. We want to make sure we maintain a high quality and not make mistakes that others have made in being too aggressive in providing, which could lead to churn. The second exciting thing is that we've actually launched an AI Scribe in April, first starting with Norwegian physiotherapists. Within two weeks, we already have over 250 + or more daily active users.
We'll do a demo of that actually later in the presentation. Third, we also signed about EUR 500,000 of new ARR in Q1 2025. On the booking portal, which we've mentioned a few times in previous presentations, it lists over 1,650 therapists now in Finland only, and we process over 3,000 bookings a week. That number, we should see that number continue to increase over time as we unlock new different ways of booking, for example, insurance company bookings or Kela bookings and so on. This is a really big part of our strategy as we want to make sure that we provide the best patient experience so that going through Nordhealth.fi, and then on the other side, that will be powered by the PMS, having that two-sided marketplace. Looking at therapy, our focus is obviously on migration.
We have not focused as much on growth this year. We want to have all of our resources on the main priority, but still we have been able to grow year- over -year around 6.6%. As you can see, the net retention was 101%. One of the big drivers of it is that we have got a decision whether either A, we can build add-ons to be able to upsell to our user base, or B, we can focus on migration. We focused on B only this year. Once the migration is done, we will be able to focus more on net new add-ons, but also on going into net new markets to continue growing this business, just like we have done with veterinary, same strategy. Looking at the therapy long-term averages, we can see we have been growing around 10% a year historically.
Our new customer ARR has, as you can see, gone down in 2024 and LTM Q1 2025 as a result of our focus on migration and the fact that we are in our current markets in Norway and in Finland, we've got a lot of users already using our software. We do not have too much headroom for growth on that one, except for our expansion. Net upsell was 7.2% on average, which has remained relatively stable. Our net retention is only 102%. Churn again is on average 5.1%. There is a big difference between churn in 2021 and thereafter because we bought EasyPractice, which has a much higher churn, given that they are targeting a slightly different segment of the markets.
Over time, however, as we compare EasyPractice customers, which are the same size and specialty as our Diarium and Aspit customers, we actually see a lower churn rate for those customer types. It is more the churn rate is driven much more by customer mix than by product selection. Now looking at EBITDA minus CapEx for the BU, we have actually decided to invest a bit more on product development this year. That is the main driver in the reduction in BU EBITDA minus CapEx. These investments are all focused on being able to migrate faster at first, and then they will be on the next mission of going to net new market or going after net new add-ons. Similar to veterinary, looking at how we have grown between 2024 and 2025, we can see that there has been some growth in Finland.
We also see that in Norway, there's been a decrease actually in the ARR. This is driven normally by seasonality in that we have yearly contracts and every Q1, the people in yearly contracts, they actually decide to churn just all around the same time. It is mostly due to seasonality, which peaks in Q1. Not a huge amount of changes in Denmark as our sole focus is on migration. The important thing about why this migration is very important is that the Aspect migration will unlock around over EUR 3 million of savings by having the people move over, not because of price, but because of efficiency. For example, we do not have to have two development teams. Secondly, we do not have to pay for licenses to be able to provide the legacy software.
Third is our support. The number of support tickets per end user FTEs is significantly lower on the new platform than it is on the Aspit platform, given that it is more intuitive and automated to manage. Looking now at the migration, we can see that we have actually our cloud share of ARR has increased from 34% in 2021 to 49%. You can see an increase between 2024 and 2025 as well. Interestingly, churn for non-cloud products has been 3.7%. We have been able to keep our customers happy while they are on the legacy products. I thought we would actually do a demo of our scribe to show you how we are implementing AI dictation, but also summarization.
This is a huge thing for therapists as it enables them to spend more time with the patients interacting and less time looking at their computer while they're with patients. Let me play the video. This first one will be an AI dictation video where we'll show you how dictation works. The second video will be showing you how we convert that dictation to a summary. You see creating a journal entry.
Good morning, Mr. Patel. How have you been since our last session? Morning. It's been all right. The pain in my lower back has reduced a little, but I still feel stiffness, especially in the mornings. That's good to hear. There's some improvement. On a scale of 1 - 10, where would you rate the pain now?
Maybe around three in the morning , and it drops to about one or two by the afternoon. Okay. That's a positive sign. Have you been doing the exercises we discussed, especially the lumbar stretches and core strengthening routines? Yes. I've been trying to do them daily. I sometimes skip the evening set if I'm too tired, though. That's understandable. Consistency is important, but we'll adjust the plan so it's manageable. Have you noticed any discomfort while doing the exercises? Not really pain, but sometimes there's a pulling sensation in the hamstrings when I do the forward bends.
A couple of interesting things about this one is the main challenges. One is that we had to make it multilingual. This is in English, but it's in Norwegian, Swedish, and Finnish, and so on.
The second one is identifying the pain points that we have to solve, especially in a therapist and there are two people talking. It's very easy to figure out who's talking when you're on a video call because it uses the microphone. When you're in a room, you have to differentiate with certainty who's actually saying what. Is it the therapist saying something, or is it a patient? Those are the two problems that we've solved. You can see real-time dictation. It's very high quality, actually. Even with background noise going on, we've tried it with music in the background. The experience has been very nice for these users. Next is, once you have the recording, and it also converts it to clinical notes. Here you can see an example of how that works.
In this example, we'll just upload one to make it more efficient. You got the transcription that was created. This is for Norwegian, so some of the titles will be in Norwegian. We're not operating in markets where English is the main language, but still, I want to show you this in English because I'm guessing most people's Norwegians here are not great. You can see it's summarizing the transcription and then polishing it to make sure it's according to the different formats that are required for different specialties. You can see here that it actually creates the notes based on this. The therapist is able to fully update these notes as needed and save those. You'll be able to see the transcription and also the full notes.
This saves the therapist a huge amount of time, but especially it ensures that they're able to focus on the patient, not focus on adding their notes. Thanks. Now off to Alex for the financial update.
Thanks, Charles. Hello, everyone. Before diving into Q1 financials, I'd like to highlight that since the last call on the 11th of April, we published our annual report for 2024. Our financial results for 2024 were audited by KPMG, and the report provides a more detailed view of our financials following the Q4 2024 presentation that we did in February. The annual report is available to download on the Nordhealth website. Looking first at reported revenues, in Q1 2025, we did EUR 12.5 million of revenue, which is a 23% increase versus the same quarter last year.
Much of that growth has been in our recurring revenues, which grew by 20.7% from EUR 9.2 million in Q1 2024 to EUR 11.1 million in Q1 2025. Our share of recurring revenue remains high at 88.6% in Q1 2025 versus 90.3% in Q1 2024. Looking now at quarterly adjusted EBITDA minus CapEx, in Q1 2025, we remained broadly in line year -on -year at EUR 0.9 million. The increase in revenue of EUR 2.3 million naturally resulted in increased COGS and customer service costs, which totaled EUR 0.7 million. Notably, we reinvested much of the additional revenue into product development, an amount of EUR 1 million to drive future growth and returns. Sales and marketing investments increased by EUR 0.2 million year on year, as did professional services costs.
Turning to adjusted cash flow, in Q1 2025, we had a cash inflow of EUR 2.8 million, which is an improvement of EUR 2.1 million compared to Q1 2024. The main driver of this increase comes from movements in our trade debtors, which were EUR 1.9 million more favorable in Q1 2025 than they were last year. The largest individual item here is a payment that we received from one of our large enterprise clients in Q1 2025 for a backlog of their invoices, totaling EUR 1.1 million. Other profitability and working capital changes amounted to a EUR 0.2 million improvement versus Q1 last year. Finally, looking at the March 2025 balance sheet, the favorable cash flow results in Q1 meant that cash at March 2025 is EUR 22.2 million, of which EUR 14.9 million is in money market funds. There were no changes to goodwill in Q1 2025, except amortization and changes due to FX.
There were no material equity transactions in Q1 2025. There were no movements in treasury shares in Q1 2025, and there was no external financing in Q1 2025. The intangible assets are primarily capitalized R&D, and our equity balance remains healthy at EUR 72 million. The full detailed financial statements for Q1 2025, including the P&L, balance sheet, and cash flow, are included in the appendices. I will now turn back over to Charles for 2025 guidance.
Thank you. I want to reiterate the guidance that we have is that we are expecting organic growth of 12%-17% in veterinary and therapy recurring revenue with December 31, 2024, constant currency. The reason for that is that there are some fluctuations in revenue.
Even though we had a big inflation revenue on veterinary due to CVS implementation in 2024, we have clinics in pilot now, but we will not see as strong growth. We are predicting on the veterinary side and on the therapy side to focus on migration will impact growth in 2025. On EBITDA minus CapEx, even though we can see that it was negative EUR 1.1 million, we will be looking at EBITDA minus CapEx to stay within a EUR 2 million breakeven, plus or minus EUR 2 million, excluding, obviously, acquisitions. Just reiterating that guidance. The next presentation will be on the 19th of August, 2025. You can see the full year calendar on our website. Now, off to Q&A. I suggest that if anyone has questions, they can ask questions on the chat. I see we've got a few questions already.
What I'll do is I'll read the questions out, and then either myself or Alex will answer the questions. We got the first question. "You're off to a strong start of the year with significantly higher growth rates than the guidance. Are you expecting a slower continuation due to migration and therapy, even though products seem to be growing nicely?" Thanks for the question. The first is, yes, we are looking to be within our guidance. That is a result of one, therapy focusing on migration. The second one is it's quite bumpy, the growth in veterinary. We're focusing mostly on pilot this year. You never know what can happen, but we're not seeing that these full rollouts will be having a big impact on recurring revenue this year.
The next question is, "What are you seeing within the end clients and their markets for veterinary and therapy? In veterinary and enterprise customers, are they still growing and acquiring new clinics? Do you notice any change in decision time or investment patterns?" Let's start with veterinary. What we've seen is a slowdown a bit on the clinic performances. As a result, there's been fewer customers coming in. That has impacted us slightly in that we have a percentage of revenue with a lot of our customers. They're still growing, but less fast than they were before. The second is that on the therapy side, the growth is quite stable. However, there are some countries, such as in Finland, where the economic situation is a bit less bad, which is actually slightly. Those two markets, however, are non-cyclical.
If the cyclicality is this way, it's a way more muted effect for us. I don't see that the cyclicality of these markets affecting our growth performance. It's more our ability to execute. In terms of investment patterns, I think that we benefit in that sense in that when the markets are not as good, they don't have to raise money, or they're normally less aggressive with acquisitions. They have more operational headspace to be able to do PMS projects if you're in an enterprise clinic. Hope that answers the question. The next one is, "Should we worry that ARR contribution for new customers, the lumpy was relatively low at 6%?" That's a great question. This is more of an accounting thing.
The way we think and the way we actually account for what's new customers versus net upsell is that it's customers that were added in that quarter. For example, for CVS or Pets at Home or any big customer, even for the [RMK], it's the initial ARR in that quarter. Normally, it's only, let's say, one clinic that they have for a bit, and then they roll out all other clinics. If you're looking at true, from a business perspective, new ARR, you have to look at some of it, which is in the new customer area, but also some of it, which is net upsell. It's hard to unpack, but we have to draw the line somewhere. That's why we—I wouldn't worry too much about that.
If we actually look at it, the one way to look at it is ARPU changes over time. We can see that ARPU has grown quite a bit less than our total growth in revenue. The majority of it is because our current customers are actually rolling out net new clinics that they were piloting before, and now they're in the rollout phase. I don't see that as an issue. Where I do see an issue is basically that in ARPU growth, we've been focusing very much on the hard thing, which is acquiring net new customers. We should focus much more on ARPU increase over time, providing additional value. It's a much easier, cheaper sale to do. We can do that at any time. We've always been prioritizing capturing net new locations over upselling those on other products.
Next question we have is, "What is your go-to-market strategy for the U.S. going forward? What are the key success factors in the U.K. that you can replicate in the U.S.? How do you intend to contain the high cost of recruiting sales talent there?" The strategy for winning in the U.S. is similar to all other markets, which is basically we have to build the best product. That is a much harder thing to do in the U.S. than it is in other markets because the expectations are much higher. The competition is much higher. We have a bigger team, development team, than any other current player in the U.S., probably by two times or more. We focused this year and last year a lot on improving the core workflows of the system.
It's not about fancy net new feature, but it's about how do you reduce number of clicks from creating that new appointment from three - one or two. It's getting those efficiencies and being known in the market as the most efficient software out there. That's having good UX. The second thing is that I believe that there's a huge opportunity to be able to improve the workflows with the new AI models out there. You can see what we've done on the therapy side, and we're doing very similar things on the veterinary side, for example, for patients trying to record the interaction with the patients, where the vet will talk through things that will create automated notes. We're talking about automating patient communication to personalize it. During an average sort of consultation, a vet is there for, it's a 15-20 minute consultation.
Think about time it takes to review a patient history during that time. We can summarize that for them in a much more easy-to-read, easy-to-understand way. The strategy is mostly to win on the product. On the distribution or go-to-market, we do not need that many salespeople to be able to grow, especially with the enterprise strategy. It is more about convincing them that having one PMS is the way forward. If we think about Europe, that was not an argument we had to make, bringing everyone to one PMS because they want to have unified reporting. In the U.S., that is still not the case, where there are middlewares which create unified reporting if you are on 20 different PMSs. That is a pain point, which is less obvious.
However, the data that they can have from here is way worse than if they had a unified PMS, but it's still learning. The market in the U.S. is much earlier than we are in the U.K. or the Nordics, for example, with regard to data-driven decision-making. We're looking forward to partnering with these corporates in the U.S. to show that that is a big differentiator. There was another question, " How do you see U.S. competitive landscape evolving and what's your take on Shepherd's acquisition of Hippo Manager?" There's basically two buckets of competitors in the U.S. We've got the products which are owned by IDEX and Covetrus, such as ezyVet or Pulse.
Those we want to compete with in that they're currently doing a migration from their legacy product to their new product, which is a good opportunity for us to actually acquire those customers at that decision point. The game is all about, can they provide a solution and innovate faster than the second group, which includes us, which is basically Shepherd, Vets Bear, Instinct, and ourselves, and just probably other smaller competitors, but those are primary ones where we are competing as the innovators in the market. The way we're looking to win against them is to compound our sort of R&D advantage over time. As we mentioned before, in Europe, there has been corporatization of veterinary clinics much early on. As a result of that, we've seen how enterprises have matured, and we've matured with them that software.
We have a unique advantage in knowing how enterprise customers want to work. That is why we will try to win that market with our better knowledge and our lead in that space. There is another question on, "You have decided to increase customer acquisition costs. Where are we in these land grab phase, probably lasting still several years?" We have not increased our customer acquisition cost significantly year- over -year. I think it is a—I do not like the term land grabbing because that is with no regard to financial return. The way I think about it is, if we look at the last presentation, there are two costs required to be able to acquire new customers in new markets. One is the sales marketing costs and implementation costs or net implementation if they pay for it. It is the net profit or loss that we make from that.
That's what I call customer acquisition costs. The second cost line is the R&D. People often forget about that, but there's problems we can solve. For example, let's take the example of implementation. We can decide to use R&D resources to automate that process. We have to use R&D to be able to add the integrations for the U.S. and so on. I bunched those all together. Those two components, I'm looking to make an over 20% return on those on effort. That's how I think about spending. When we're looking at the use of cash, I always think it's best to invest in R&D in certain projects or in sales and marketing, or is it better to, let's say, invest in buying a company because it's cheaper than doing sales and marketing? That's how we think through that.
We had another question on, "Congrats on the start of the year. DNB Carnegie, formerly known as Carnegie, is currently covering Nordhealth. Could you elaborate on how you're engaging with other investment banks to broaden analyst coverage at Nordhealth?" That's a great question. It's actually one of the things I've been working on over the last year, trying to get a second and hopefully a third bank to be able to cover us as well, as I think that Nordhealth is a stock that should have a bit more liquidity. That's one of the points that we're trying to improve over time. We had a question on, "What are your medium-term expectations for the therapy division once the migration is completed? Can growth accelerate towards 15%-20% like the vet division, or is it more of a profitability play?" That's a great question.
If we go back to where we started, at first, we only had cash to be able to, before the IPO, to finance one of the businesses. We chose Veterinary at that time. Post-IPO, the bottleneck was not cash, actually, but the bottleneck to be able to grow both was management capacity. At that point, Valter took over the Veterinary business units. Only recently, actually, Karan took over the Therapy business, which means we've got additional management capacity to be able to grow two things at once. The team still on the unified platform is still quite small. I want to focus them on one mission at a time. That's been the big learning since I started, actually. It's better to do things sequentially, but faster than in parallel. Jack of all trades is master of none.
That was a hard lesson to learn, but I think now that's the best way to create value. I think it's the most efficient as well. First, we'll be doing this migration, and then we're always quite pragmatic with things. It's either if we see opportunities to grow organically in net new markets, we'll look at that. Otherwise, if we see opportunities to grow by acquisition and migration, or we could also look at just expanding our sort of share of wallet in our current markets or a combination thereof. We haven't yet made a decision on medium-term profitability or not. It really depends on the opportunities. For now, we're focusing on the migration, and our plan will be to do something similar to what we did in Veterinary, conquering one new market at a time.
If we do not find opportunities, which I do not believe, I do believe we might find some opportunities to grow. I believe that we will go after a net new market. The final question we have is, "Are you seeing anything new in the M&A and private equity space in terms of interest in kinds of assets as Nordhealth, for example? Has there been any transaction recently? If yes, what have the multiples looked like?" There is a lot of interest in P2Ps in the Nordics, and specifically in SaaS. The transactions of similar companies in the Nordics, I do not have exact multiples of what they trade at. I am sorry, I cannot help on that. There are rumors, but I do not want to comment on the rumors of what those are. Great. Perfect. Thank you very much, everyone, for your time.
I'm just going to see if there's any other questions. No other questions. Thank you. Thank you very much, everyone, for your time. Have a nice day. Bye.