My surgeon required clearance from a phycologist, cardiologist, and pulmonary MD's. He also required an endoscope and a colonoscopy Final clearnace prior to my surgery will be by my primary MD. My insurance required a letter of medical nessesity, three months under a registered dietains care, and various other requirements. I spent a lot of time and money to complete all of these appoinments and having various tests performed (chest x-ray, CT scan of my chest, echocardiogram, stress test etc..) I began in June and I booked everthing as soon as I possibly could. My surgery date is December 8, 2010! I do not have any medical problems other than obesity. And I still went to more than 18 appointments! I am just thinking about the end result to help me through all of these challenges! Good luck! In the end this will all be worth our time and effort!