Patient Endorsement Form

Share your experience with Dr. Daniel Poulsen, MD, PhD — Interventional Radiology

Your feedback helps us continue providing excellent, patient-centered care. This form may be submitted digitally or printed and completed by hand.

Your Information

Your Endorsement

Please share your experience regarding the care you received — clinical skill, communication, comfort, and overall outcome.

Rate Your Experience

Would Recommend to Family or Friends

Clinical Skill & Expertise
Communication & Bedside Manner
Professionalism & Courtesy
Patient-Centered Care

Signature & Consent

I consent to this endorsement being shared for professional, credentialing, or marketing purposes by Poulsen Medical, P-LLC. I understand I may request that identifying details be withheld or that my endorsement be shared anonymously.

Poulsen Medical, P-LLC · Interventional Radiology · Thank you for helping us improve patient care.