Reciprocity Rx™ Provider Intake Form

Let’s begin where you are.

WELCOME.
Whether you’re curious about incorporating seasonal rhythms, movement practices, land-based care, or simply creating space for stillness and reflection, this session is a grounded place to start.

Your Reciprocity Rx session includes:

  • A 60-minute 1:1 call with Sydney Williams (founder of WITW Consulting + Hiking My Feelings)
  • A customized follow-up summary with aligned resources, ideas, and programs
  • Ready-made resources to prescribe reciprocity with nature for your patients, clients, and community.
  • Optional access to licensing opportunities for existing programs + resources
  • A space to explore new ideas or adapt your current offerings into something more nature-rooted and regenerative
Cost: Sliding scale — more details below.

This form helps us get a feel for where you’re starting from and how we might support you best. It’s not a test — just a way to begin the conversation intentionally.

We’re so glad you’re here.

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👤 BASIC INFORMATION
First Name *
Last Name *
Pronouns *
Email *
Phone Number *
City *
State *
Business Name / Website / Social 
Where can we learn more about you and your work?
🌱 ABOUT YOU + YOUR WORK
Tell me a bit about your role as a care provider and the communities you serve.
What kind of work do you currently do?  *
If you identify with multiple modalities or roles (e.g. therapist, coach, artist, healer), feel free to include them all.
Who do you primarily work with? *
(populations, age range, needs)
How long have you been in this field or practice? *
🥾 YOUR PATH TO THE TRAILHEAD
Every path here is different — we’d love to hear about yours.
How did you find out about Reciprocity Rx or WITW Consulting? *
What drew you to this work with nature?  *
could be personal, professional, both
What aspects of nature-based work are you most interested in exploring? *
 (select all that apply)
Required
💭 INTENTIONS + HOPES
This isn’t about a perfect plan — just where your heart is pointing right now.
Why are you interested in Reciprocity Rx™ at this moment in your life? *
What are you hoping to gain, clarify, or explore during our time together? *
Are there any specific ideas, programs, or challenges you’re sitting with that you’d like to explore further?  *
🧭 ALIGNMENT CHECK
This part helps us make sure we can offer the kind of support you’re looking for.
Have you ever led or facilitated any of the following? *
select all that apply
Required
Are you open to adapting your existing work to include land-based practices, metaphors, or seasonal rhythms? *
Is there anything else you'd like to know before we meet? *
📆 FINAL STEPS
Once your form is submitted and reviewed, we'll follow up via email to confirm next steps. Please add hello@witwconsulting.com to your contacts and check all the places emails go (other than your inbox) if you haven't heard from us with 3 business days.
Sliding Scale Fees *
We offer a limited number of sliding scale 1:1 sessions each month to increase access for young professionals, BIPOC, LGBTQIA2S+, and frontline care providers. If the full rate isn’t accessible for you, we offer two reduced-rate tiers ($275 and $125) to increase equity and access. No explanation is required — we trust you to choose the rate that feels right for you.

Supporter: $750
For those with financial abundance who want to help fund reduced-rate sessions for other providers. Your contribution directly increases access - thank you. 

Sustaining: $450
This rate supports you, the integrity of the work, and the sustainability of the offering.

Supported: $275
For those with steady income who may not have the budget for the full rate. A gentle middle ground.

Accessible: $125
For those with limited financial access, including folks between roles, young professionals, BIPOC, LGBTQIA2S+, and frontline providers.

I’d like to receive occasional updates about new nature-based offerings, trainings, or peer circles. *
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