You are probably going to have to see a Thai shrink anyway. Mine spent an hour with me, going through my trans history and then reviewing the letter from my specialist. The cost of the entire consultation, including the certification for surgery was $25. Suporn doesn't make an extra charge but then I'm told his psych spoke very little English. Chets Psych is almost inevitably going to pass you, particularly if you have a referral from a doctor (only one is necessary as you have to see a Thai psych anyway). However if you go with just one referral he charges around $300 for his psych to provide you with a certificate. It's almost all profit for Chet, but in the scheme of things it's not a lot extra to pay. Remember Chet isn't going to schedule your surgery if he believes that you may not be able to gain the Thai certificate to go ahead.