Private Consultation Terms, Governance & Clinical Pathway Conditions
Last updated: May 2026
Dr Ksenia Alex
Please read these Terms, Governance and Clinical Pathway Conditions carefully before booking or attending an appointment.
These conditions outline the structure under which private consultations, diagnostic ultrasound services, strategic reviews, integrative medicine consultations, and related clinical services are provided by Dr Ksenia Alex.
The purpose of this document is to ensure clear clinical governance, appropriate allocation of consultation time, safe communication pathways, and professional boundaries for both patients and clinician.
1. CONSULTATION CATEGORIES
The clinic provides several consultation pathways depending on the complexity, scope, and nature of review required.
Standard Consultation Pathway
Examples may include:
  • Alexandra Initial Consultation
  • Alexandra Hospital Follow-up
  • Advanced Initial Consultation
  • Combined Scan & Consultation
  • Early Pregnancy Viability & Assessment Scan
  • Virtual Follow-up Consultation
These consultations are intended for focused specialist review within the allocated appointment duration.
They may include:
  • history taking,
  • review of relevant investigations,
  • ultrasound examination where appropriate,
  • explanation of findings,
  • and formulation of an initial management plan.
Standard consultations do not automatically include extensive review of large historical records, external investigations, multidisciplinary timelines, or prolonged strategic case analysis unless specifically arranged.
Where the complexity of a case exceeds the reasonable scope of the booked consultation type, transition to a Complex Gynaecology Consultation, STRATA Consultation, or Functional Medicine Strategy Consultation pathway may be recommended.
Complex Gynaecology Consultation / Strategic Review
These consultations are intended for patients with substantial diagnostic or management complexity, including but not limited to:
  • recurrent miscarriage,
  • recurrent IVF failure,
  • egg donation complexity,
  • fertility treatment complexity,
  • extensive prior surgery,
  • multidisciplinary histories,
  • complicated hormonal or reproductive histories,
  • complex external investigations,
  • advanced ultrasound interpretation,
  • or prolonged strategic review requirements.
These consultations may require:
  • structured pre-submission of records,
  • extended review time,
  • chronology review,
  • strategic interpretation,
  • or staged follow-up planning.
Additional review appointments may be required where substantial further information is later submitted.
STRATA Consultation
STRATA Consultation is a structured pathway-based consultation intended primarily for selected patients with:
  • endometriosis,
  • adenomyosis,
  • chronic pelvic pain,
  • complex inflammatory or hormonal reproductive presentations,
  • fertility optimisation concerns related to these conditions,
  • or patients entering the STRATA pathway structure.
Additional pathway information may be available through:
STRATA by Dr Ksenia Alex
The STRATA pathway may involve:
  • staged assessment,
  • strategic planning,
  • integrative discussion,
  • ultrasound review where appropriate,
  • prioritised investigation planning,
  • and structured follow-up.
Virtual – Functional Medicine Strategy Consultation
This consultation is intended for patients seeking a broader integrative and strategic review approach.
This may include discussion of:
  • lifestyle,
  • hormonal patterns,
  • nutrition,
  • inflammatory contributors,
  • environmental factors,
  • functional medicine principles,
  • reproductive optimisation,
  • or broader systems-based review where clinically appropriate.
This consultation pathway requires prior preparation and submission of relevant information in advance where requested.
The consultation is intended to provide structured strategic guidance rather than continuous ongoing messaging-based care.
Focused Review Call
Focused Review Calls are short follow-up reviews for existing patients only.
These calls are intended for:
  • clarification of previously discussed plans,
  • focused review of agreed results,
  • minor adjustments related to existing management,
  • or brief follow-up clarification.
These calls are not suitable for:
  • new clinical problems,
  • extensive reassessment,
  • complex interpretation of large result sets,
  • multidisciplinary review,
  • emotional crisis support,
  • or urgent concerns.
Where additional complexity arises, a full consultation may be required.
2. PAYMENT, BOOKING & APPOINTMENT CONFIRMATION
Appointments are confirmed once payment has been processed through the booking system.
A valid payment card is required when booking appointments.
Virtual consultations, strategic reviews, STRATA consultations, and Functional Medicine Strategy Consultations generally require payment in advance.
Where significant review work has already commenced, consultation fees may remain payable even if the appointment is later cancelled or not attended.
3. REGISTRATION, PORTAL ACCESS & INACTIVE ACCOUNTS
Creating access to the patient portal or beginning registration does not itself establish an ongoing consultant-patient relationship.
Patients are responsible for:
  • completing registration requirements,
  • providing requested administrative information,
  • providing financial details where required,
  • and booking appropriate appointments.
Where a portal account remains inactive without:
  • completed registration,
  • appointment booking,
  • or meaningful communication regarding intended booking,
the account may be archived after reasonable administrative reminders.
Typical onboarding reminders may occur approximately:
  • Day 3,
  • Day 10,
  • with archive/deactivation generally occurring between Day 14–21 where no progression or communication has occurred.
Patients who have not booked appointments are not considered under active clinical care.
4. DOCUMENT UPLOADS, RECORD REVIEW & EXTERNAL INFORMATION
Submission or upload of documents, investigations, letters, imaging, blood tests, questionnaires, or external reports does not confirm:
  • review,
  • interpretation,
  • monitoring,
  • clinical action,
  • or ongoing clinical responsibility.
Uploaded information may not be reviewed immediately, comprehensively, or at all unless relevant to an agreed consultation structure.
The consultation fee includes reasonable review of clinically relevant information appropriate to the booked consultation type.
Extensive review of:
  • large historical records,
  • unsorted documentation,
  • duplicated material,
  • multidisciplinary timelines,
  • external imaging,
  • fertility treatment histories,
  • or substantial additional information
may require:
  • additional consultation time,
  • further review appointments,
  • restructuring into a Complex Consultation pathway,
  • or additional professional fees where appropriate.
Patients submitting extensive documentation may be asked to provide:
  • concise chronology,
  • summary of current concerns,
  • medication list,
  • and priority questions.
The clinic may limit review of excessive, unsorted, duplicative, or non-relevant material where this exceeds the scope of the booked consultation.
5. COMMUNICATION & CLINICAL MESSAGING
Email, portal messaging, and administrative communication systems are intended primarily for:
  • appointment administration,
  • onboarding,
  • operational communication,
  • and limited clarification where appropriate.
These systems are not intended for:
  • ongoing unscheduled clinical management,
  • repeated medical advice,
  • urgent concerns,
  • emergency review,
  • or extensive interpretation of results.
Complex clinical discussions generally require a scheduled consultation.
Limited clarification may occasionally be provided where operationally feasible; however, ongoing messaging-based care is not provided.
Messages may not receive same-day response.
The clinic may not provide continuous availability due to:
  • clinical workload,
  • annual leave,
  • NHS commitments,
  • conferences,
  • illness,
  • or operational closure periods.
6. PRIVATE CARE DOES NOT CONSTITUTE CONTINUOUS MONITORING
Private consultations provide episodic specialist assessment and do not constitute:
  • continuous medical supervision,
  • unrestricted clinical access,
  • emergency cover,
  • or ongoing monitoring of uploaded information.
Patients should not assume that investigations or uploaded records are being continuously monitored outside agreed consultation structures.
Patients remain responsible for arranging appropriate follow-up appointments and seeking urgent medical care where required.
Follow-up Responsibility and Dormant Pathways
Patients are responsible for arranging recommended follow-up appointments and responding to clinic communications where ongoing review has been advised.
Where follow-up has been recommended but:
  • appointments are not arranged,
  • communications are not responded to,
  • or ongoing engagement does not occur within a reasonable timeframe,
the patient pathway may become inactive or dormant.
Reasonable administrative attempts at communication may be made where appropriate; however, the clinic cannot provide indefinite ongoing follow-up without active patient engagement.
Private care does not constitute continuous monitoring or ongoing responsibility in the absence of agreed follow-up arrangements and active patient participation.
Patients experiencing new, worsening, or unresolved symptoms should seek appropriate medical review through the clinic, GP, NHS services, or emergency services where appropriate.
7. NHS AND PRIVATE CARE PATHWAYS
Private care and NHS care pathways operate separately, including where the same clinician is involved in both settings.
Private communication systems, portal messaging, consultations, and administrative channels must not be used for management, escalation, or coordination of NHS care outside formally arranged private consultations.
Review of NHS investigations, imaging, correspondence, or treatment plans during a private consultation does not transfer responsibility for:
  • ongoing NHS management,
  • monitoring,
  • prescribing,
  • follow-up,
  • or clinical coordination.
Patients who are not formally under the clinician’s NHS care remain under the responsibility of their relevant NHS teams and local NHS governance pathways.
Where patients are under both NHS and private care with the same clinician, NHS care remains subject to NHS governance structures, NHS operational processes, local service capacity, waiting list systems, administrative pathways, and NHS clinical policies.
The clinician’s role and operational capacity within NHS services differs from private practice settings and may be subject to limitations relating to:
  • appointment availability,
  • investigation access,
  • theatre allocation,
  • administrative support,
  • referral pathways,
  • multidisciplinary processes,
  • and local NHS service structures.
Private consultations do not override NHS operational systems or guarantee accelerated NHS investigations, appointments, procedures, communication pathways, or treatment timelines.
8. CONSULTATION TIME & PRIORITISATION
Consultations are allocated defined appointment durations.
Where multiple complex concerns are presented, prioritisation within the available consultation time may be necessary.
Additional appointments may be required for comprehensive review of all issues raised.
Where sufficient time has not been allocated for safe review of complex information, additional consultation time or further appointments may be required.
9. VIRTUAL CONSULTATIONS9. VIRTUAL CONSULTATIONS
Virtual consultations may be conducted by secure video or telephone systems where clinically appropriate.
Remote consultations have recognised limitations, including:
  • inability to perform physical examination,
  • technical interruptions,
  • limitations of image or video quality,
  • and reduced ability to assess certain symptoms remotely.
Patients are responsible for ensuring:
  • privacy,
  • stable internet connection where possible,
  • appropriate contact details,
  • and access to a suitable device for the consultation.
Where possible, patients attending virtual consultations should ensure access to:
  • a sufficiently charged and functional device,
  • stable connection,
  • appropriate audio capability,
  • and an environment suitable for confidential and focused clinical discussion.
Certain consultations may require:
  • screen sharing,
  • review of imaging,
  • discussion of reports,
  • diagrams,
  • or visual explanation of findings.
Inadequate technical setup, repeated interruption, inability to access visual material, attendance in unsuitable environments, or significant distraction may reduce the safety, effectiveness, or overall quality of the consultation.
Attendance during activities such as travel, shopping, driving, work-related interruption, or other distracting circumstances is discouraged where possible, particularly during complex consultations requiring detailed discussion or review of imaging and investigations.
Where virtual consultation conditions are considered insufficient for safe or effective assessment, the clinician may recommend:
  • continuation in limited form where appropriate,
  • conversion to face-to-face review,
  • or rearrangement of the consultation where clinically and operationally feasible.
Rearrangement or additional follow-up due to technical, environmental, or organisational limitations cannot be guaranteed and may be chargeable depending on the circumstances and time already allocated.
10. ULTRASOUND & DIAGNOSTIC LIMITATIONS10. ULTRASOUND & DIAGNOSTIC LIMITATIONS
Ultrasound and diagnostic imaging are valuable clinical tools but have recognised limitations.
The examination provides a targeted assessment based on the clinical history, symptoms, referral information, and indications discussed at the time of consultation. It may not assess all organs or detect all abnormalities in every case.
Diagnostic accuracy may be affected by factors including:
  • image quality,
  • body habitus,
  • bowel gas,
  • prior surgery,
  • disease stage,
  • technical limitations,
  • anatomical variation,
  • and the nature or location of pathology.
Certain conditions, including early endometriosis, microscopic disease, subtle inflammatory changes, or functional disorders, may not always be detectable on ultrasound.
Ultrasound findings must be interpreted alongside the wider clinical assessment and should not be relied upon in isolation for diagnosis or treatment decisions.
Where findings outside the intended scope of specialist assessment are identified or suspected, further review or alternative specialist assessment may occasionally be recommended.
Further investigations, repeat imaging, MRI, referral, or alternative assessment may still be recommended where clinically appropriate.
External imaging and third-party investigations may vary significantly in quality, methodology, interpretability, and clinical utility. The clinic may determine that certain external investigations are insufficient or unsuitable for reliable clinical interpretation or decision-making.
For certain clinical questions, patients may be advised to attend ultrasound assessment at a specific stage of the menstrual cycle where this is considered important for optimal interpretation and diagnostic accuracy.
The clinic may utilise advanced ultrasound technologies, structured imaging assessment methods, and adjunctive image-analysis tools where clinically appropriate to support assessment of particular conditions. These tools assist clinical interpretation but do not replace consultant clinical judgement.
11. EARLY PREGNANCY SCANS
Early Pregnancy Viability & Assessment Scans are limited to first-trimester assessment.
Early pregnancy findings may occasionally remain inconclusive and follow-up scans may be required.
The clinic does not provide emergency obstetric services.
Patients experiencing:
  • heavy bleeding,
  • severe pain,
  • collapse,
  • ectopic pregnancy concerns,
  • or urgent symptoms
must seek urgent NHS or emergency medical assessment.
12. INTEGRATIVE & FUNCTIONAL MEDICINE PRINCIPLES
Recommendations relating to:
  • nutrition,
  • lifestyle,
  • supplements,
  • environmental factors,
  • functional medicine principles,
  • or broader integrative strategies
are intended to support overall clinical management and do not replace:
  • emergency medical care,
  • GP supervision,
  • fertility clinic management,
  • or standard medical treatment where required.
Implementation of recommendations remains a shared decision between the patient and their treating clinicians.
13. PROCEDURES
Procedures are governed separately through procedure-specific consent processes.
Separate procedural risks, benefits, limitations, and aftercare instructions will be discussed where relevant.
14. RECORDING OF CONSULTATIONS
Patients are requested to inform the clinician if they wish to record consultations.
Undisclosed or covert recording may affect confidentiality, professional trust, and the open nature of clinical discussion.
The clinic reserves the right to decline recording where considered appropriate for clinical, confidentiality, or professional reasons.
Where recording practices are considered to have significantly undermined trust, professional boundaries, or the therapeutic relationship, the clinic reserves the right to reconsider continuation of private care where clinically appropriate.

15. EDUCATIONAL USE OF ANONYMISED IMAGES
Anonymised ultrasound images, imaging clips, or de-identified clinical material may occasionally be used for:
  • professional education,
  • teaching,
  • training,
  • service development,
  • or professional presentation purposes
in accordance with confidentiality and UK GDPR requirements.
Identifiable personal information will not intentionally be included.
Use of anonymised material does not affect patient care.
16. RESPECTFUL BEHAVIOUR & PROFESSIONAL BOUNDARIES
The clinic is committed to maintaining a professional and respectful environment.
Abusive, aggressive, threatening, manipulative, or inappropriate behaviour towards clinical or administrative staff will not be tolerated.
The clinic reserves the right to decline or discontinue private care where safe and professionally sustainable boundaries cannot be maintained.
17. CLINICAL SUITABILITY & LIMITATIONS OF PRIVATE CARE
The clinic may determine that certain cases are more appropriately managed through:
  • NHS pathways,
  • tertiary multidisciplinary services,
  • emergency services,
  • local treating teams,
  • mental health support,
  • or alternative specialist pathways.
No guarantee of diagnostic outcome, fertility outcome, symptom resolution, treatment success, pregnancy achievement, or clinical improvement can be provided.
18. URGENT MEDICAL CONCERNS
The clinic does not provide emergency medical services.
Portal messaging, email, and administrative communication systems must not be used for urgent medical concerns or emergency escalation.
Patients requiring urgent medical attention should contact:
  • NHS services,
  • NHS 111,
  • GP services,
  • fertility emergency services where appropriate,
  • or emergency services.
19. AGREEMENT
By completing registration, booking appointments, attending consultations, or using clinic systems, patients acknowledge that they have read, understood, and agreed to these Terms, Governance & Clinical Pathway Conditions.
Additional consultation-specific information, onboarding guidance, and pathway documents may also be provided separately through clinic systems, websites, or patient communications where relevant.