Hey Gina,
Seems like it's been ages since we last talked,
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
(hmmmmmmmmmm but then so are the others <shrug> )
Chat later
Steph