Too little and too much fluorine are potentially hazardous for human health. In the Jiaokou Irrigation District, ionic concentrations, hydrogeochemistry, and fluoride contaminations were analyzed using correlation matrices, principal component analysis (PCA), and health risk assessment. The patterns for the average cation and anion concentrations were Na⁺ > Mg²⁺ > Ca²⁺ > K⁺ and SO₄^2- > HCO₃^– > Cl^– > NO₃^– > CO₃^2-. The fluoride concentrations ranged between 0.29 and 8.92 mg/L (mean = 2.4 mg/L). 5% of the samples displayed lower than the recommended limit of 0.5 mg/L fluoride content, while 69% exceeded the allowable limits of 1.5 mg/L for drinking. The low F^– content is distributed in a small part of the southeast, while elevated F^? mainly in the central area of the study region. The PCA results indicated three principal components (PC), PC1 having the greatest variance (45.83%) and affected by positive loadings of TDS, Cl^–, SO₄^2-, Na⁺, and Mg²⁺, PC2 accounting for 17.03% and dominated by Ca²⁺, pH, HCO₃^–, and K⁺, and PC3 representing 12.17% and mainly comprising of CO₃^2?. High fluoride groundwater is of the SO₄-Cl-Na type, followed by HCO₃-Na type. Evaporation and ion exchange play important roles in producing high fluoride groundwater. Furthermore, saturation index and anthropogenic activities also promote the high fluoride concentrations. The values of the total hazard quotient of 93% groundwater samples were greater than 1 for infants, followed by 85% for children, 68% for teenagers, and 57% for adults. Non-carcinogenic health risks to infants may occur over the entire study area, while for adults, health risks are mainly found in Weinan and Pucheng. High fluorine may have a potential negative influence on neurodevelopment, especially for infants and children. Adults in this region have serious dental fluorosis and skeletal fluorosis because of long-term drinking of high fluoride groundwater. Therefore, measures, including using organic fertilizers, strengthening defluoridation process, and optimizing water supply strategies, are necessary in this area.