Myrtle Beach Counselor | (843) 650-1030 | cbgalton@gmail.com

Myrtle Beach Mental Health Counseling

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Counseling Client Forms

If you are new to therapy or counseling, please be sure to fill out the following forms, and bring them to your first session. This will help ease you into therapy and allow as much time as possible to focus on you.

Client Intake

Authorization to Disclose Protected Health Information

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Christopher Galton, LPC



(843) 650-1030
cbgalton@gmail.com

106 Black River Road
Myrtle Beach, SC 29588

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Office Hours

Mon-Thu: 9am-7pm
Sat & Sun: By Appointment Only
Sat & Sun: For emergency

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Contact Information

106 Black River Road
Myrtle Beach, SC 29588

(843) 650-1030
cbgalton@gmail.com

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