Due to the stressful nature of the job, firefighters are likely to be at increased risk for behavioral health problems. This study examined the access, attitudes, and preferences of a large sample of professional firefighters (N = 2,156) toward behavioral health services using an online survey. Overall, 81% of participants reported that they had access to behavioral health services through their fire service department, although smaller departments were less likely to offer such services. Despite available programs within fire service, firefighters most commonly reported that they would seek outside help from their spouse/family (67%) or private professional services (60%). Firefighters with fewer years in service were more likely to go to a spouse/family member, coworker, or officer for help, whereas those with more years were more likely to seek private professional services. Few firefighters directly stated that stigma would prevent them from using behavioral health services, yet a large percentage of firefighters (68%) reported that they would not recommend these services to colleagues, and stigma-related barriers were still among the most significant reported. “Clinicians who understand firefighter work culture” was rated as one of the most important components to a successful behavioral health program; a lack thereof rated as one of the most significant barriers. Offered together, these findings suggest that greater exploration of stigma in fire service is warranted, and attention toward training culturally competent clinicians to work with firefighters is needed.