Welcome to our anonymous chaplaincy & peer support form. All information collected is necessary to provide services for you, but kept completely confidential. No personally identifying information or uploads are required. We look forward to the opportunity to serve you, and help you find comfort where you are.

Should you feel you are a threat to yourself or others, or if you need medical attention, stop filling out this form and call 911 or visit the closest emergency room.

Full Name (Optional)

Phone *

Occupation *

More Details

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All Information is Kept Secure & Confidential

What type of service(s) can we provide you with? *

Peer Support Specialists

Chaplaincy Support

Other (Describe Below)

Date Request Submitted *

What other services may we assist you with?

Have you ever used our services before? *

All Information is Kept Secure & Confidential

This information is obtained only to improve your experience with Guardian Grounds Ranch & Camp Comrade. All answers are kept confidential and only utilized to provide services needed, or suggest opportunities to you.

1. Have you served in the military or as a first responder? *

2. Have you received any previous mental health or peer support services? *

3. Are you comfortable discussing any traumatic experiences you may have had during your service? *

4. Have you ever worked with a chaplain before? *

5. Are you currently connected with any peer support groups/organizations for veterans or first responders? *

6. Are there any specific triggers or concerns we should be aware of when providing you with services or accommodations? *

7. How can we best support and assist you while receiving services for mental wellness, chaplaincy, or peer support? *

8. Please tell us anything about you that we may have missed above! *

9. What activities/hobbies do you enjoy? *

10. Please list any current exercise and stress reduction activities. *

Thank you for taking the time to provide us this information. We absolutely value your privacy and make every attempt to keep your information completely anonymous, private and secure. The information collected on this form is necessary to provide you with services. We will be in touch as soon as possible to assist you.

If you feel you are a danger to yourself or others, or in need of medical attention, please call 911 or visit the nearest emergency room.