I am a licensed clinical social worker in FL, Idaho, Virginia; licensed independent clinical social worker in Massachusetts, Minnesota, and Rhode Island.
I graduated from Barry University in 2014 and have been working within the mental health and hospital field since.
I enjoy helping others overcome the challenges life throws at them. With the right mindset, support and environment, I believe change is possible.
I provide psychotherapy services to individuals in a collaborative, supportive, and safe environment.
Hi! I'm a Licensed Clinical Social Worker (LCSW) based in Virginia and LCSWC in Maryland. I received my Masters from Virginia Commonwealth University and have been practicing for over 20 years. My history and background is inclusive of treating adults with specialty population of veterans and persons that have experienced trauma. I work one on one with adults struggling with stress with regards to self worth challenges, recovery from toxic relationships, navigating the complexities of co-parenting or healing after relationship break up or divorce. I treat the individual while considering their whole health needs and help them to heal and become the best version of themselves. For clarification, I do not specialize in couples work or family- based therapy. I work with individuals only, one-person in the session only.
Welcome! I'm Stephanie Freeman,MSW, LCSW, LCAS.
Take a moment to acknowledge you've taken the first step towards bettering your mental health because, let's be honest - starting therapy can be empowering, confusing, or scary, all at the same time.
I strive to create a safe and welcoming environment that allows clients to explore obstacles with concerns related to anxiety, depression, and/or self-care. I focus on helping clients develop assertive communication & boundaries with themselves and those around them that can help improve their quality of life.
Counseling can foster personal development in whatever way you may be seeking and help build the life you so deeply deserve. If that's what you're looking for, I'm here when you're ready to share.
Hi, I am a licensed clinical social worker (LCSW) with over 20 years of social work and mental health experience. I utilize evidence-based therapy models focused on my clients' strengths, abilities, and unique life experiences in efforts to improve quality of life and restore overall health and wellness. I greatly enjoy my work with clients and the reward in my work is seeing clients succeed and overcome life's challenges.
Welcome, My name is Ariam Peña, I am a Licensed Professional Counselor in Georgia and Virginia. I received my Master’s degree from Argosy University and have been practicing for over a decade. I help adults with the different challenges of life and pressures that often take the form of anxiety, depression, stress, and substance abuse. I work to help my clients navigate these transition periods and to build skills to allow them to feel better about themselves and develop a more positive outlook on life.
I am an experienced professional with a strong background in supporting people facing a wide range of concerns, including anxiety and depression, life changes, lack of confidence, communication issues, and chronic illness. I work collaboratively with clients to identify practical, meaningful changes that can create the greatest positive impact in their lives.
My approach is interactive, respectful, direct, encouraging, and sometimes includes a bit of humor. I strive to create a supportive environment that is both encouraging and authentic.
If you’re ready to move toward meaningful change, I invite you to take the first step today.
I do not treat substance abuse or addictions. I do not do court related work.
My name is Michael Starr, and I am a Licensed Independent Clinical Social Worker. I believe therapy is more than just problem-solving, it’s a place to rediscover who you are, heal what’s been hidden, and move forward with clarity and strength. I work with individuals, couples, and families facing anxiety, trauma, relationship challenges, identity questions, and emotional overwhelm.
My style is honest, grounded, and deeply respectful of the human experience. I use evidence-based approaches like Cognitive Behavioral Therapy and Trauma-Focused CBT, but I also hold space for what cannot always be explained, your story, your meaning, your growth.
Clients often come to me feeling stuck, disconnected, or unsure of how to move forward. Together, we uncover the patterns keeping you there and build the insight, skills, and resilience to move through them. You won’t be rushed or judged. You’ll be heard, supported, and challenged when needed.
You don’t have to have all the answers. You just have to be willing to start. Healing begins with one honest conversation, and I’m here to take that step with you.
This is my fourth year in the social work field, and I have been in my own solo practice for a year. I am independently licensed in NC, SC, VA, and OR as an LCSW/ LISW-CP. I am also a Certified Doula, Perinatal Behavioral Health Coach, Women's Mental Health Specialist, and Autism Clinical Specialist.
In my off time, I love binge-watching Netflix and spending time with my children.
Hi, I’m Brandy—Licensed Clinical Professional Counselor and Licensed Mental Health Counselor with over two decades of experience helping people navigate life’s challenges.
For the past 25 years, I’ve worked across diverse settings in the mental health field, with 20 of those years as a licensed clinician. At my core, I’ve always been a helper—someone who believes deeply in the power of connection, healing, and growth.
Chinelo Okpalobi is a Licensed Mental Health Therapist with over 10 years of experience working with children, adolescents, adults, couples and families.
Let's celebrate this first win of many, deciding to embark on your therapy journey. I'm here to be your teammate, but most importantly, your accountability partner. I take a client-centered, collaborative approach to therapy, tailoring each session to your unique needs and goals.
There isn't a manual on how to start; once you feel ready, I'm here to guide you through conversation. I’m here to provide a safe and supportive environment where you can be yourself and learn more about yourself.
My zeal is to equipping individuals and families to be successful through collaboration of treatment goals and exploring innovative solutions,
I am passionate about creating environments for individuals to excel by overcoming obstacles/barriers.
My drive in practice comes from a quote by MLK “If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.”.
I am a licensed psychologist who provides evidence-based, compassionate care for adults and adolescents. My approach integrates Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Internal Family Systems (IFS), and clinical hypnotherapy to support meaningful and lasting change. I focus on helping clients develop practical coping skills, deepen self-understanding, and strengthen emotional resilience. I strive to create a collaborative, non-judgmental environment where clients feel supported as they work toward their goals.
I hold a doctorate (Ph.D.) in Psychology and a Master's in clinical social work. I am licensed as a clinical social worker in Florida, Maryland, Nevada, Virginia and South Carolina with 37 years of professional work experience. I have experience in helping clients with stress and anxiety, coping with addictions, relationship issues, & family conflicts. I have authored two books (Bad Therapy Good Therapy: And How to Tell the Difference; and Grow Up, America!); five booklets; and thousands of articles, as well as a self-help column, "Life's a Beach," published in Gannett newspapers since 2005. My primary goal is to help you help yourself. I will guide and coach you, not tell you what to do. We'll reason and think our way to what makes sense together.
I have over 15 years experience providing therapy and case management including in the areas of: Anxiety issues; Medical and chronic pain issues; sexual relationship struggles and relationship/couples challenges; phobias; eating disorders and body image challenges; Post residential and outpatient maintenance therapy for continued abstinence and sobriety from substance use and eating disorders; fertility and conception issues; LGBTQ and gender concerns; and couples counseling (without legal involvement).
I am distinguished by my training in Strengths Based Therapy, Cognitive Behavioral, Pain Reprocessing Therapy, Emotional Freedom "Tapping" technique, Acceptance and Commitment, Mindfulness, and Contemplative Care. I am licensed in CA, ID, VA, FL, TX, NJ, and WA.
** I do not provide services for individuals/couples involved in active litigation, divorce proceedings, or child custody disputes, nor do I provide court-ordered evaluations or expert testimony**
There is a way out. Those who come to see me are often at a crossroads, frustrated at how they are trying to deal with problems and seeking workable strategies and solutions to cope. Therapy is meant to be a space to feel welcome to talk about thoughts, feelings, and behaviors that are problematic. Understanding unhealthy behaviors, frustrations with life, and/or unsuccessful efforts to cope can help reveal the obstacles that may block your path to growth and desired outcomes.
Why do we explore? So you can live a life YOU want to live!
Dr. Norman Quintero is a Licensed Mental Health Counselor with over seven years of clinical experience providing therapy to individuals and couples. He is licensed to practice in California, Texas, Virginia, Louisiana, and Florida, and specializes in the treatment of anxiety, depression, trauma, relationship difficulties, grief, stress and anger management, and self-esteem concerns. Dr. Quintero utilizes an integrative therapeutic approach that combines Cognitive Behavioral Therapy (CBT) with humanistic principles, fostering a safe, supportive, and non-judgmental environment in which clients feel heard, validated, and empowered to achieve meaningful and lasting change in their lives.
I’m a licensed clinical social worker who believes therapy works best when it feels safe, honest, and collaborative. I bring experience from community mental health, forensic settings, and private practice, and I show up as a real person—not a blank slate. I work to create a space where clients feel understood, challenged when needed, and supported as they work toward meaningful, lasting change.
I am a compassionate, client-centered therapist who works with individuals navigating anxiety, life transitions, relationship challenges, and issues related to self-worth and identity. I strive to create a safe, supportive space where clients feel seen, heard, and empowered to better understand themselves and their patterns. My approach is trauma-informed and integrative, drawing from evidence-based practices while honoring each client’s values, strengths, and lived experiences.
Michelle Maddalozzo is an LCSW in private practice in Illinois. She holds a Masters in Social Work from the University of Chicago and a Doctorate in Social Work from the University of Tennessee. Michelle has been working with mood disorders, depression, anxiety, and trauma for over the past ten years while specializing in military mental health. She incorporates different treatment modalities into her work, with an emphasis on body-oriented techniques. She sees adults and adolescents for individual therapy. She has successfully worked with many diverse clients, who presented such issues as depression, anxiety, traumatic stress (including experiences of domestic violence, sexual assault, adult survivors of childhood abuse, medical trauma, and single or complex incident traumas such as car accidents/combat), grief, relationship difficulties, difficulty transitioning to parenthood, college or career.
Michelle has a strong passion for helping individuals meet their life goals and uses evidence-based practice and body-oriented techniques to help clients manage their challenges, celebrate the joy, and recognize their full potential, self-esteem, and stress management.
Hi! I'm a Licensed Professional Counsellor (LPC) based in Virginia. I received my Masters from South University of Florida and have been practicing for 10 years. I would love to assist you in your journey to wellness. I have experience working with individuals struggling with chronic pain, using CBT to address cognitive factors contributing to pain perception. I strive to be inclusive and sensitive to the needs of LGBTQ+ individuals.
Hello! I am a Licensed Professional Counselor (LPC) based in the heart of VA. I earned my Masters in Clinical Mental Health Counseling from Liberty University in 2020 and have been practicing for the past five years. My approach to therapy comes from a place of validation and hope: believing that you have it within you to be the person you want to be!
Welcome! I'm Zena Jones
Take a moment to acknowledge you've taken the first step towards bettering your mental health because, let's be honest - starting therapy can be empowering, confusing, or scary, all at the same time.
I strive to create a safe and welcoming environment that allows clients to explore obstacles with concerns related to anxiety, depression, or self-care. I focus on helping clients develop assertive communication & boundaries with themselves and those around them that can help improve their quality of life.
Counseling can foster personal development in whatever way you may be seeking and help build the life you so deeply deserve. If that's what you're looking for, I'm here when you're ready to share.
I am a clinical mental health counselor (LPC), currently studying for my Doctorate. I am passionate about supporting individuals through life’s challenges by creating a safe, nonjudgmental space where clients feel heard and understood. My approach is collaborative and integrative, drawing from evidence-based methods such as CBT, DBT, mindfulness, and trauma-informed care to meet each person’s unique needs. I am committed to helping clients build resilience, improve emotional well-being, and move toward meaningful personal growth. Also I speak Farsi too.
Hi, I'm Barbara! A warm and compassionate soul, with 25+ years in the mental health field. I spent most of my career working in community mental health settings and have the breadth of varied experiences that entails. I'm familiar with the court and judicial system, the state mental hospital system, and worked alongside numerous other entities (DSS, FAPT, CSU, schools, courts, probation, pre-trial, CASA, drug and alcohol treatment centers, state health agencies, community services boards, healthcare providers, private acute facilities, and other BH healthcare entities). I was educated at Loyola University, New Orleans (BA in Psychology), later earning a Master's degree/Professional Counseling, in Central Virginia. I'm licensed in the State of Virginia and have worked with folks from all different age groups and walks of life. My career began working with children and families, which still holds a very special place in my heart.
I am a clinical social worker bringing a lifetime of experience to my work, helping clients to identify what's working and what changes they may consider making.
I am eclectic in my approach, most often using cognitive behavioral therapy, brief therapy and positive psychology.
I identify as a long-time member of the LGBTQ community and am constantly striving to become more culturally sensitive and aware. I work with persons across the lifespan: ages preschool through seniors.
I bring my sense of humor, ability to adapt and switch gears, and my huge heart and compassion to the work that I do!
Welcome! With over 20 years of experience and a Doctorate in Counseling Psychology granted at the Interamerican University of Puerto Rico, I am best positioned to serve individuals and families navigating challenges such as family conflicts, trauma, PTSD, and anxiety. My therapeutic expertise extends across various cultural contexts, having practiced in Puerto Rico and Massachusetts, and currently holding active licenses in Maryland and Virginia.
*PLEASE CHOOSE A SESSION AT LEAST ONE WEEK FROM TODAY. ALL CLIENTS MUST BE AT LEAST 21 YEARS OF AGE TO BOOK. Hello! I am a licensed professional counselor who has been working in the field for over 30 years. I am predominantly a cognitive behavioral/rational living therapist who focuses on you, the client, and your relationship with yourself and creating the existence you've always wanted. I have a dry sense of humor and believe that honesty with my clients is the way to help them reach their goals. My therapy style is conversational, so I offer feedback and input throughout the session as opposed to sitting silently, and I give homework to help each client work on the skills we've discussed in session. I look forward to meeting you and being a part of your journey!
Welcome! Seeking therapy can be intimidating, but you're making the right decision. Having personally navigated the challenges of mental health stigma, I'm acutely attuned to the diverse cultural backgrounds that shape individuals' experiences. This insight fuels my passion for breaking down barriers and fostering a safe, inclusive environment for everyone. I firmly believe that a strong therapeutic alliance is built upon feeling comfortable and understood, and I am dedicated to being that source of support for my clients. I'm committed to guiding you toward a more meaningful life, harnessing the incredible power of resilience and personal growth.
Welcome! My name is Marian Robinson, and I am a Licensed Clinical Social Worker (LCSW), in Pennsylvania, New Jersey, Virginia, Maryland, and the District of Columbia with over 20 years of professional mental health experience. I have experience in helping clients with low motivation, relationship issues (individual), self-esteem and confidence, career difficulties, mood disorders, anxiety, depression, grief, and end of life issues. I take an eclectic, person-centered approach, CBT and psychodynamic approach where you are in the driver seat in your own recovery. I am here to support you in that process and will meet you where you’re at, without judgment. Taking the first step to sign up for therapy takes courage and I would be proud to help you get started.
I’m a Licensed Clinical Social Worker in Virginia and California with a doctorate in Integrated Behavioral Health. I show up in therapy as a real person first. I know how important it is to have a space where you can be seen and understood without judgment. My doctoral training strengthens my clinical work by deepening how I integrate behavioral health, medical understanding, and whole-person care.
My style is warm, honest, and down-to-earth. I don’t use labels to define you. I listen, reflect, and walk with you through whatever challenges you’re facing. While I am not a psychiatrist and do not prescribe medication, I work collaboratively and thoughtfully within the full scope of care. Whether it’s stress, anxiety, depression, or shame, I help you untangle what feels heavy so you can move toward healing, clarity, and peace.
Hello! I am so glad you came across my profile; and that you are considering taking this very important step towards changing your life. I am a licensed clinical social worker, based in the Raleigh Durham area of North Carolina. I am licensed in North Carolina, Connecticut, Florida, and Texas. I received my undergraduate degree from the University of North Carolina at Wilmington and my graduate degree from the University of Georgia.
I have spent the majority of my career in healthcare settings and working with adults who are experiencing challenges with mental health. I help clients with long-term health conditions find effective coping skills as well as meaning and acceptance in their diagnosis. I have also worked with children who have a loved one facing a life-altering medical diagnosis.
My experience is not limited to working with individuals who are facing a medical diagnosis, as I also have worked extensively with clients facing depression, anxiety, interpersonal challenges, self-esteem issues, and end-of-life challenges. I view therapy as a collaboration, as you are the expert of your own life; we will work jointly to create a treatment that is both realistic and meaningful so that you can live a full and value-driven life!
I have a certificate to provide tobacco cessation counseling for individuals looking to live a smoke-free lifestyle.
Born and raised in the inner city by a single mother and a large extended family, I noticed the needs of those that were mentally or physically diagnosed were often not met. Therefore, I began to inquire about what I needed to do in order to be a part of the solution. I began to work in the field and I have worked in Behavioral/Mental Health for close to 20 years. My experience covers a plethora of ages and diagnosis across many settings. My determination to treat and support those with mental health diagnosis during the pandemic inspired me to perform outpatient therapy via telehealth to adults and adolescents. I specialize in adults 25-55 with various diagnoses but primarily Anxiety, PTSD, trauma and Depression to name a few. I love to utilize CBT, CPT, trauma informed care (TIC) and Motivational Interviewing as treatment modalities.
Hello and Welcome! I am a Licensed Professional Counselor in the state of Virginia. I have been working in the mental health and counseling profession for 28 years. I also have a Ph.D. in psychology and philosophy with published research on family caregiver stress. I strive to build a collaborative trusting relationship with all of my clients, while also providing them with a warm, safe space to openly express their feelings about past and present issues. I feel it is important that every client feel understood, supported, validated, and comfortable in their sessions. After all, this is your healing journey which I am hopeful to support and guide you along the way.
My name is Alicia Thompson, and I’m a licensed clinical social worker in Virginia. I deeply believe in the power of therapy to support individuals through good times and the bad, and I’m passionate about helping my clients develop skills to address challenges such as trauma, depression, and anxiety. My goal is to empower clients to care for themselves in ways that are both healthy and productive.
Summer Post is a Licensed Clinical Mental Health Counselor with over 7years of experience working with individuals who are coping with severe persistent mental illness, depression, anxiety, trauma, family conflict, substance use, and many other presenting issues that individuals may be struggling with. Summer Post utilizes a wide range of tools to address clients' presenting issues. Summer is looking forward to meeting with you.
If you’re here, chances are life feels heavy right now, and maybe you’re tired of pretending you’re okay when you’re not. I get it. Being a teen or young adult can feel like too much sometimes; emotions are big, people don’t always understand, and everything seems to be changing all at once.
Hi, I’m Shimyne Homidas, LCSW, and I’m glad you’re here. Reaching out for support is a powerful first step, and you don’t have to do this alone. I am the heart behind In Your Space, a place for real conversations, real emotions, and real growth.
Greetings, I am a newly licensed Clinical Social Worker (LCSW) based in Virginia. I earned my Master of Social Work from the University of Southern California and have accumulated 12 years of experience in the field. My focus is on assisting adults and their families become more psychologically flexible as they navigate the complexities associated with chronic illness and internal and external stressors. Which can lead to greater resilience, emotional tolerance and better quality of life.
VirtualOffers in-person in Mechanicsville, VA - Accepting clients in VAAvailable
I have been independently licensed since 2016. I have worked in many areas of social work so my knowledge in the field is very diverse. I have worked out patient, hospital and in patient. I am trained in EMDR and can provide CBT and psycho therapy.
I offer therapy that focuses on what you need to live your life to its fullest. I can treat trauma, anxiety, depression and many other diagnoses that clients struggle with. I hope to be able to help you. I try very hard to make my sessions tailored to what you as a client need. I am very person centered and i want to make this experience as therapeutic as I can.
Tileda Brown, LCSW, CSAC
Licensed Clinical Social Worker | Certified Substance Abuse Counsel | Individual Therapy
Welcome!
I'm a Licensed Clinical Social Worker with over 8 years of experience supporting individuals through life’s most challenging transitions. I specialize in cognitive behavioral therapy, anxiety, depression, relationship issues, substance abuse and self-esteem. My approach is warm, collaborative, and rooted in evidence-based practices, including Acceptance and Commitment Therapy , Cognitive Behavioral Therapy (CBT), and mindfulness-based interventions.
I work with adults navigating issues such as:
Struggling with Depression
Anxiety and panic disorders
Grief and loss
Relationship and attachment issues
Life transitions (divorce, career change, etc.)
In our work together, I strive to create a safe and nonjudgmental space where you feel heard and empowered. Healing isn’t linear, and I believe therapy should move at your pace. Whether you're feeling stuck, overwhelmed, or simply seeking deeper self-understanding, I’m here to support you.
Hi! I'm a Licensed Clinical Social Worker (LCSW) based in North Carolina. I received my Masters from West Virginia University and have been practicing for 8 years. I specialize in clinical assessments, including Comprehensive Clinical Assessments (CCA) to support diagnosis and referrals to outpatient providers, as well as work accommodations, FMLA, and ESA assessments. I do not conduct ADHD or autism evaluations.
LaTonya Jones is a board certified Licensed Professional Counselor in the state of Virginia. She has a BS in Criminal Justice from Old Dominion University and a MS in Counseling Studies from Capella University. She has over 25 years of experience in Mental Health. LaTonya’s area of interest is empowering Women and teenage Girls. She has worked with adults, teens, couples and families. LaTonya provides a range of therapeutic and psychotherapy services to include depression, anxiety, PTSD, stress, adjustment disorders, grief and loss, addiction, life transitions and anger management.
LaTonya strives to empower her clients to ultimately arrive at a place of emotional and mental stability. LaTonya encourages her clients through use of autonomy to recognize their resilience and their ability to overcome all types of challenges. Through rapport building, LaTonya creates a safe and trusting environment that allows the client to “Trust the Process” and “Show themselves Grace”.
VirtualOffers in-person in Chesterfield, VA - Accepting clients in VAAvailable
Many of us navigate the world using the survival skills we learned in our childhood. We often grew up learning to view and interact with the world in a way that made us feel safe. Now, some of these survival styles hinder us from building deeper connections with others and ourselves. Our marriage becomes challenging, family interactions feel superficial, and we often feel the need to be vulnerable but don't out of fear of judgment. This stops us from connecting with others, establishing boundaries, and making better decisions.
Hello! I am a Licensed Professional Counselor (LPC) based in Virginia with 20+ years of professional work experience. I earned a Master of Arts in Clinical Mental Health Counseling from South University. I am an approved Clinical Supervisor by the Counseling Board of Virginia. My experience has included working in both public and private sectors, in outpatient, hospital, detention centers, schools and community-based settings, providing mental health treatment to children, adolescents, and adults.
Hello, my name is Luiza and I am the owner/therapist of FIT MIND counseling services. I am a Licensed Mental Health Counselor in FL and a Licensed Professional Counselor in DC, GA & VA. I am from Brazil, and I speak Portuguese as well :)
FIT MIND counseling services enjoys empowering clients finding a more meaningful way to live their lives and assisting them learning about the importance of self-love. Helping clients to focus on themselves and on their self-care is a precious thing. When they learn to embrace and unconditionally love for being themselves, they become stronger in the face of negativity and more able to hold onto positive thoughts when faced with challenges.
Mental illness is as real as any physical illness. We talk normally about cancer and diabetes, although the same should apply to mental illness. Emotional and mental health are just as important as the physical health of a human being. The emotional trauma that a brain endures in various of the human life cycle can be damaging and in the long run, just as detrimental as a psychical illness.
People donate their organs, but they cannot donate their brains. Some people live with human-made hearts, but there is no such thing as human-made brains. I believe that our brain is the most important organ in our human body, so why don’t we start taking good care of it?
Therapy is not only for people with mental illness. Therapy is for everyone. We all have faced or currently face some hardships in life. Talking to a therapist can help you deeply in improving your mental health, decrease your stress and live with more joy and intention! Make your appointment today!
My name is LaTonya Thomas and I am a license clinical social worker. I have been in the mental health field for over 14 years and has worked with clients with anxiety, depression, grief, life transition and many more diagnosis. My goal is to help the clients become aware of what may be going on with them and ways to handle it.
I am a licensed marriage and family therapist with almost 20 years experience. I have taught college classes in psychology, which gives me a unique perspective in understand why we behave the way we behave. I love the brain and try explain some of our behaviors based on what I have learned about the mind and how it works. As a marriage and family therapist, I look at behaviors as a reflection of our past and present circumstances.
Hello,
My core belief is that all people are created equal; therefore, everyone has equal right to leave to their fullest potential. I earned my master’s in social work from University of Maryland, School of Social Work, Baltimore, MD in 2010. I have Licensed Certified Social Worker - Clinical (LCSW-C) in MD, Licensed Independent Clinical Social Worker in DC and Licensed Certified Social Worker (LCSW) in VA. For more than 10 years, I have utilized Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), humanistic, person-center, strength-focused therapy and other psychotherapy Intervention to assess, plan, implement and evaluate individual or family in diverse therapy environment. I am commented to assist people to live life to their fullest potential because we all have one life to live, and we deserve to be in peace with ourselves. I have worked with people in LGBTQ+ community both in individual and couple session. I am WPATH qualify to write gender affirming surgery letter.