Please complete each section as thoroughly as you feel comfortable. Your information is kept private and handled with care.

Let’s begin.

Step 1 — Tell Us About You

Share some basic information so we know a little about you.

First name

Last name

Email

Phone

Date of Birth

Month

Day

Year

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Step 2 — What Brings You In

Tell us what you’d like help with and what you’re hoping to accomplish.

If other, please explain how I can help you.

Step 3 — Insurance Information

Provide your insurance information and drivers license.

Drivers Licence

Insurance Card - Front

Insurance Card - Back

As a Psychiatric Nurse Practitioner, I provide a supportive, judgment-free space where clients feel heard and understood. Together, we'll develop a personalized plan to help you achieve your mental health goals.

Jennifer Somerville | Essex Psych NP

Psychiatric Nurse Practitioner, FNP-BC, PMHNP-C

Welcome, Let’s Get Started

Taking the first step toward better mental health is important.
We’re glad you’re here.