Hey Gina,
Seems like it's been ages since we last talked,
![Smiley :)](https://www.susans.org/Smileys/susans/smiley.gif)
just kidding. I'm not an expert on this, but I'm sure there are others here who would be better able to advise you.
I think that generally, most reputable surgeons require at least one letter certifying that you are a fit candidate for GRS (not sure if that's the right wording) I know Menard & Brassard in Montreal requite two letters, one from a doctor, and one from a therapist. I believe that most surgeons in Thailand require one letter. The best thing would be to contact surgeons individually and find out what their
"current" requirements are.
I have no idea of the ethics involved with surgeons who do not need letters, my only guess would be that they are in it only for the money
![Undecided :-\](https://www.susans.org/Smileys/susans/undecided.gif)
(hmmmmmmmmmm but then so are the others <shrug> )
Chat later
Steph