Referrals

Chest, hand and arm of a white person in a white lab coat, arms crossed, holding a gently folded stethoscope. Bright white background.

Referrals

Referral Forms

If you are referring yourself or a friend to JaxCareConnect, please fill out the form below.

If you are a community-based organization or hospital partner and would like to refer a client to JaxCareConnect, please fill out the form below.

2026 FEDERAL POVERTY LEVELS

Size of
Household
200%
monthly
200%
yearly
250%
monthly
250%
yearly
300%
monthly
300%
yearly
1$2,660$31,920$3,325$39,900$3,990$47,880
2$3,607$43,280$4,508$54,100$5,410$64,920
3$4,553$54,640$5,691$68,300$6,830$81,960
4$5,500$66,000$6,875$82,500$8,250$99,000
5$6,447$77,360$8,058$96,700$9,670$116,040
6$7,393$88,720$9,241$110,900$11,090$133,080
7$8,340$100,080$10,425$125,100$12,510$150,120
8$9,287$111,440$11,608$139,300$13,930$167,160