|Family Size||Last 30 days income MUST be less than|
|Add $696 for each additional person|
|Hospital Referral||New Patient Form||Appointments|
Patient must be resident of Duval County
Age 18 and above
Patient must NOT have any health insurance
You must bring a proof of income. This includes a last paycheck, Social Security Disability, or a Notarized letter of support document in case of no income.