Progress to report. I still don't have the letter in my hands, but I had an appointment with my HRT doctor, who will be coordinating my surgery and recovery. Without the letter, the meeting is a bit premature, but the letter is immanent. (I made the appointment a month ago to discuss a plan B, when it looked like it would be another year before I got my second letter. It was easier to keep it than to make a new one.)
So, I filled in the application form for insurance funding. As soon as the second letter comes in, she will sent the whole package off to the insurance people. Apparently, their replies are coming quickly now: weeks, instead of months. With their approval, she will send the application off to Dr. Brassard's clinic. She said not to expect a reply from them in less than three months. Brassard's waiting list is currently about 12 months, though I do hear from time to time of people getting in quicker if there is a cancellation.
My doctor said that she doesn't think I will need an attendant when I go to Montreal. The main purpose of an attendant is to carry luggage on the return journey. Since I won't have a lot of luggage, it shouldn't be too hard to get cabbies, porters and airline staff to help with that. She has another client who has physical and mental disabilities, who went on their own and had no difficulties, in spite of having the full-depth procedure. I will be getting the zero-depth procedure, and I am in excellent health, so I should expect to be in better shape than that client when I return.
TL;DR
I signed the form and pressed the "start button" on my surgery application.