The fourth season begins with a nice wedding of an unexpected couple and kiss at the airport for couple Bright and Hannah in Everwood.
Nina finally chooses between the two men she loves - Andy and Jake while at Delia's behest. Amy develops a new friendship with college-age student Reid (guest-star Justin Bardoni) while waiting on her mother Rose at the hospital. Also, Amy and Rose find that Rose's cancer has driven them apart rather than brought them together. Bright flirts with a new girl who might become his roommate, but is more involved in knowing what girlfriend Hannah scribbled off the postcard that she sent to him. Lastly, Ephram makes an emotional return to Everwood just in time for an unexpected wedding.

Andy learns that Ephram has no intention of moving back home, while Bright invites Ephram to move in with him and Reid (Justin Baldoni). Meanwhile, Hannah (Sarah Drew) begins to worry about the long term possibilities for her relationship with Bright after he shares his "three dates and out" policy; Harold suspects Andy is up to something after he frequently goes missing from the office.
Nina and Jake have the grand opening for their new restaurant, Sam's. Nina is having a hard time convincing Everwood patrons on her new restaurant politics as "Mama Joys" is officially gone. But Nina gets some help when a couple of celebrities walk in and like her new establishment. Lastly, Ephram and Amy finally confront the unspoken fate of their relationship.

As if adjusting to college life and the news that her secret crush, Reid (guest star Justin Baldoni), is gay weren't enough to handle, Amy learns that Ephram is going to be a regular fixture in her life now that he's moved in with Bright and Reid. Meanwhile, Andy, Nina and Jake attempt to move on with life after Nina decides which man she loves - which is Jake. Bright and Ephram take Hannah to a college party.
Andy gets involved in a case dealing with 17-year old Ethan Harcourt who is on anti-depressants since his older brother's car accident and passing, but now wants to be intimate with his current girlfriend. Although, the anti-depressants he is taking is causing erectile dysfunction for him and tries to coerce Andy in letting him have Viagra. Ethan wants to keep all of this a secret from his girlfriend and family who don't know about his situation.
Andy wavers that he's too young but Ethan doesn't listen and purchases medication online that inevitably ends him up in the hospital after

Ephram is back in town and is giving piano lessons at ECC now. Ephram begins his piano tutor session with a 13 year-old Kyle Hunter who has a major attitude. He doesn't want to play the "classical crap" though. He wants to go to Julliard, which Ephram finds funny but isn't as amused when he insults him a lot on his Julliard past. Nevertheless, once Kyle starts playing he is extremely good and Ephram is intrigued.

Bright tries to invite Ephram on a camping trip along with his dad Harold and Andy, but Ephram is reluctant even though he and Andy are doing a bit better. Ephram eventually does go though. Also, while Amy is working to get a play together she is mortified that her signals towards Reif were way off in her attempt to pursue a relationship with him. But they do eventually kiss.
Ephram meets Kyle's mother, Tracy and thanks Ephram for all he has done for him. She also sets insight on why Kyle is the way he is, which leaves Ephram more contented that Kyle is just like him. Jake treats a 40 year-old woman who has stress urinary incontinence - someone who keeps wetting themselves and having no control over it. Edna has been quite perplexed lately as Jake is opening up his private office more for surgical procedures and botox sessions.

Wanting to fix Andy and Jake's friendship, Nina suggests that the men go to counseling to sort out their differences with a professional. Meanwhile, Andy tells Ephram that Amy might have a boyfriend; Rose deals with losing the mayoral election; and Ephram continues to learn the about the complications in Kyle's life.

Hannah's mother (guest star Jayne Brook, "Chicago Hope") pays an unexpected visit to Everwood to tell Hannah that her father has passed away. Elsewhere in Everwood, Ephram stifles his feelings for Amy while forced to watch her relationship with Reid (guest star Justin Baldoni) grow more serious; Andy advises a patient (guest star Keith David, "Crash") who desperately needs a kidney transplant, but refuses to accept one from his daughter (guest star Gina Ravera). Lastly, Bright is at a loss at how best to help Hannah through this difficult time.

With Hannah leaving for Minnesota in a few days with her mother (guest star Jayne Brook, "Chicago Hope"), Bright and Amy find themselves taking the loss of their girlfriend and best friend, respectively, harder than even they expected. Jake sets out on a high-risk bike trip with his friend, Cliff (guest star Simon Rex), that takes a near fatal turn; Andy and Harold uncharacteristically decide to go skydiving after hearing of Jake's daredevil ways; and Reid (guest star Justin Baldoni) keeps his promise to Ephram and backs off from pursuing Amy, leaving her feeling all the more lonely.

A very-much-in-love Ephram discovers that he has unwittingly become a "girlfriend" to Amy, but the friendship takes a turn for something more when a moment of intimacy leads to them waking up together the next morning. Meanwhile, Nina grows suspicious of Jake's recent strange behavior, which is further amplified when his brother, Brian (guest star Tom Parker), shows up unexpectedly. Delia takes up with the popular girls in school, which worries Andy. Also, Bright tries to rectify Hannah's low self-esteem issues. Lastly, Rose drops some startling news on Harold, which could drastically change their lives.

Amy and Ephram try to sort out their relationship and future after they sleep together. Jake and Nina's relationship hits a bump when Nina learns about Jake's addiction to prescription drugs. Andy re-examines his life after reading Irv's description of him in Irv's novel. Meanwhile, Amy meets a cool, new teacher at Colorado A&M and Ephram spends more time with Kyle.

Ephram falls deep into a depression when he can't figure out his relationship with Amy. He only gets more depressed once he hears that Will Cleveland, his former piano teacher and mentor, has passed away. Bright tries to cheer him up, his style, by taking him to a college keg party, but Ephram doesn't respond to the girls hitting on him and decides to just play video games instead. After urging from a new professor, Amy decides to get involved with Planned Parenthood, but this creates a rift between her and Hannah when Amy tries to get her to volunteer as well. Meanwhile, Edna suffers a panic attack and Andy takes her to the hospital; Harold and Rose decide to adopt a child, but get caught up in the complexities of doing so; and Delia continues to grow more rebellious.

Andy goes to a Rabbi, Josh Stein, for help in planning Delia's Bat Mitzvah. Despite bringing back feelings about his own lost son, Ephram supports Kyle as his estranged father returns to town. Andy tries to get a date with a woman over the Internet, but is forced to postpone several times, including once to help Nina through an emotional crisis brought on by Jake's recovery. Meanwhile, one of Amy's college professors consults Harold about a medial procedure.

An eighteen-year-old girl comes into Andy's clinic to be checked for breast cancer because it runs in her family. When the results come in, the girl and her older sister, who has had a double mastectomy due to breast cancer, return to see them. Meanwhile, while out on a date, Bright and Hannah are forced to call Harold after something happens to the both of them and Kyle tells Ephram that he no longer wants piano lessons.

Andy and Jake are having a little get-together before work when a car crashes into a lamppost in front of them. Both doctors immediately detect the person in the car had been drinking. Harold meets a member of Rose's cancer support group. Jake checks up on the drunk guy in the hospital and ends up having a good talk with him. Reid has a discussion with his academic counsellor. Amy takes Hannah out to a restaurant where she meets with her college friends.

Bright makes a mistake that threatens his relationship with Hannah; Kyle gets a Juilliard audition and Andy, knowing this news triggers feelings of regret in Ephram, encourages his son to try another music school; Nina tells Andy she wants to propose to Jake; and Amy reluctantly brings Laurie to her parents' house for dinner.

Ephram discovers that Bright cheated on Hannah and confronts him about it. Irv takes Edna along on his book tour, where they meet his daughter Cassie. Reid is faced with expulsion from medical school for cheating on an exam. Harold confesses to Andy that he neglected to report Rose's cancer on the adoption application. Ephram tells Amy what happened with Bright, prompting her to confront him and force him to admit the truth to Hannah.

Ephram finds Reid unconscious after overdosing on pills in a failed sleeping attempt. Bright, feeling miserable after their breakup tries to fix things between him and Hannah. Meanwhile, Laurie suggests that Amy go to Washington D.C. for a conference, but when Amy meets Laurie's daughter, she re-evaluates her opinion of her professor; and Nina, struggling with her feelings for Jake, discovers that she still has feelings for Andy.

Just out of the hospital and wanting to start his life over, Reid asks Amy out on a date. Amy talks a very reluctant Hannah into a double date with Amy's friend Nick, leaving Bright to deal with his pain and jealousy. Delia panics when her Bat Mitzvah falls on the same day as the birthday party of the most popular girl at school. Nina tries to deal with her confusing emotions over Andy and realizes she will have to make a decision when Jake asks her to move to Los Angeles with him. Harold points out to Rose that they were so caught up in the adoption procedure they've been taking each other for granted.

Andy's father, whom the Brown's haven't seen in 15 years, pays a visit to Everwood surprising Andy, Ephram and Delia. Ephram and Amy try to cheer Bright up and take him out to celebrate his 21st birthday. This ends badly when a drunk Bright falls through a window and ends up in hospital. Hannah rushes to Bright's side, leaving Nick behind on their date. Jake's big question last week, gets an answer from Nina as she has decided to move to LA. Andy is not happy about this. Edna and Irv decide to drive all over the country for their retirement.

Nina's struggle to figure out who he loves more between Andy and Jake takes new development when Ephram tells her his father bought an engagement ring. Memories brought back to Amy about Ephram and her, making her revaluate everything about each other. Learning about something he and his father are both involved, Andy and Gene wind up to have a long conversation about their feelings for one another. Figuring out not everything is lost, Bright and Hannah establish a new friendship.

While packing up her house and preparing to leave Everwood with Jake, Nina tells Hannah that she knows Andy bought an engagement ring for her. Hannah convinces Nina to sneak into the house while the Browns are out to get a look at the ring. Later, Jake finds out about the ring and confronts Andy once again about his feelings for Nina. At Delia's Bat Mitzvah, Amy watches Ephram with his new girlfriend Stephanie, and realizes her feelings for Ephram are still strong. When one of Harold's patients leaves her baby on the Abbott's doorstep, Harold wrestles with the right course of action while Rose immediately becomes attached to the little girl.

With their house being sold, but their new house not ready for them to move into, Nina and Sam temporarily move in with the Browns. Andy, wanting to take care of unresolved issues from the past, takes a road trip before proposing to Nina. Meanwhile, Bright learns that Hannah got a scholarship to Notre Dame and is devistated when he learns that she might take it; Andy becomes increasingly attached to the baby girl left on his doorstep; Delia is elated with Andy's late Bat Mizvah gift; Amy reveals her feelings for Ephram to Stephanie, who won't loose Ephram without a fight; and Harold and Rose deal with the news that Edna is leaving Everwood.