Chaplain Request Form

Chaplains provide pastoral support and counseling services within the limits of their training, education, and denominational mandates. Chaplains are available for consultation to assist in referrals for therapy and other supporting resources. Chaplains do not provide psychological therapy or counseling.

An Intake Specialist will respond to your request within 24 hours.

HTN does not provide emergency services. Our chaplains are available to provide support from a spiritual or religious perspective to those struggling to cope with their current situation, in need of advice, looking to reconnect with their faith, find new faith, or trying to interpret life through a spiritual lens. However, people in crisis and in need of immediate help should contact:

In the U.S.:

911
Veterans Crisis Line:
- 1-800-273-8255, press 1; or
- Text 838255

In Canada:

911
1-800-268-7708
1-800-567-5803 (TDY/TTY)
Visit: Veteran Affairs Canada

First Name^*

Last Name^*

Have you submitted a chaplain request before?^*

Has any of your contact or location information changed since the last time you requested chaplain support?^*

Phone Number

Email^*

Location (U.S. State or Country if outside of U.S.)^*

What is your race/ethnicity (optional)

What is your preferred language (optional, we cannot guarantee a chaplain match)?

Do you self-identify as a religious person?

Religion/Denomination

Best way to reach you:^*

Phone
Email

Best times to reach you^*

Please provide a range of times that you may be reached.

Your current timezone.^*

Select your current U.S. Timezone or the continent you are in if you are stationed overseas.

Please provide a brief summary of the issue(s) you want to discuss with a chaplain.^*

This information will only be shared with those who are directly involved in providing care.

The following fields are optional. They may help us locate the right chaplain for you but we cannot guarantee a chaplain matching your preferences is available. We will assign the best fit we can.

Name of Preferred Chaplain

If you have worked with one of our chaplains before and would like to speak with her again, enter her name now. We cannot guarantee she will be available.

Preferred Chaplain Religion/Denomination

Preferred Chaplain Race/Ethnicity

Preferred Language (if your preferred language is English leave this blank)

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