Ok, thanks. Don't have anything I'm aware of. Just doing a lot of reading and people saying unless you're sure, then withhold. Thanks,
@Clip4
If you are not 100% certain you will be issued, request that the AME do the exam as a consultation. If the AME or staff refuse, find a different AME.
If the AME agrees, complete the MedXpress, print it, and cut off the confirmation from the bottom. This provides the AME with all of the information on the form, but prevents the staff or the AME from "accidentally" making the exam go live. Expect to pay the normal fee for the exam.
If he says he cannot issue, then continue to withhold the confirmation number and discuss in detail why he cannot. Find out if the deficiencies can be overcome and by what means. Also find out the exact process that happens once you have all the documentation he is asking for, especially if the result means deferral and additional review at OKC or Washington DC.
If after the consultation examination the AME says he is able to issue your certificate before you leave, then surrender the confirmation number so the AME can "open" the file, make his entries, and print your certificate.
Doing a thorough physical exam with your regular physician is always a good place to start. Tell him or her that you are planning to get an FAA medical certificate, provide them any info they need, and ask that you be checked over to determine if there are any items that would throw you under the FAA bus. If there are, fix them before seeing an AME, or at least be ready to get appropriate documentation from this doctor to satisfy the FAA.
If ever any doubts, seek the advice, education, and guidance of a properly qualified flight surgeon before submitting anything to the FAA. This step alone may save you loads of money, time, and frustration over "bombing into the office" like Dr. Bruce describes.