Please fill out the form below (it will only take a minute) so I can learn a bit more about you and determine if we’re a good fit. After you submit the form, you’ll receive an email with next steps.

Looking forward to speaking with you!

Griffin Coombs, IHP

Creator of The Energized Educator

Today's Date *

YYYY

Name *

First Name

Last Name

Email *

Age *

Location *

How did you hear about the program? *

What are the ways that low energy is affecting your life? Please be as detailed as possible. *

Describe a typical day of food & liquid intake for you. Please be specific. *

Have you ever done an elimination diet or experimented with avoiding certain foods? Please explain. *

Please list any vitamins, supplements, or medications you take regularly. *

Approximately how much sleep do you get nightly? *

Less than 6 hours

6-7 hours

7-8 hours

More than 8 hours

It varies all the time.

Do you usually wake up with a dry mouth? *

Yes

Unsure

Describe your current activity level. *

Do you move regularly? How often and in what ways?

Have you ever worked with a health coach or done a health coaching program in the past? Please explain. *

If yes, was it helpful? What did it help or not help you achieve?

Are you committed to making the changes necessary to regain your energy? *

e.g. Removing certain foods; trying new foods; taking foundational supplements; changing sleep and exercise habits; minimizing alcohol consumption; prioritizing self-care habits; etc.

Yes

I'm still on the fence

Are you able to set aside a fixed day & time for 1:1 coaching calls every 2 weeks for the duration of the program? *

Yes

Unsure

If you answered "yes," please list your availability for fixed bi-weekly sessions. If you answered "no" or "unsure," please elaborate.. *

Is there anything else you'd like me to know?

Thank you! Please expect an email from me within 24-48 hours.

hello@thenorthstarbody.com

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