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pay.gialliance.com Open in urlscan Pro
2606:4700::6812:6e3e  Public Scan

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Submitted URL: https://pay.gialliance.com/l/576179194947/
Effective URL: https://pay.gialliance.com/welcome/?link=576179194947
Submission: On September 12 via manual from IN — Scanned from US

Form analysis 11 forms found in the DOM

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="en">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input type="submit" tabindex="0" class="text-0_875 s768:text-1 tracking-0_2 leading-1_5 text-left bg-white capitalize px-24 py-8 w-full border-none hover:bg-gray-f3f4f7  text-primary-3667e9 font-500" lang="en" value="English">
</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="es">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input type="submit" tabindex="0" class="text-0_875 s768:text-1 tracking-0_2 leading-1_5 text-left bg-white capitalize px-24 py-8 w-full border-none hover:bg-gray-f3f4f7 text-gray-65657b" lang="es" value="español">
</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="en">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input tabindex="-1" class="text-1 bg-white list-style-none my-12 capitalize tracking-0_2 leading-1_25 border-none  text-primary-3667e9 font-500" type="submit" value="English">
</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="es">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input tabindex="-1" class="text-1 bg-white list-style-none my-12 capitalize tracking-0_2 leading-1_25 border-none text-gray-171731" type="submit" value="español">
</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="en">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input type="submit" tabindex="0" class="text-0_875 s768:text-1 tracking-0_2 leading-1_5 text-left bg-white capitalize px-24 py-8 w-full border-none hover:bg-gray-f3f4f7  text-primary-3667e9 font-500" lang="en" value="English">
</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="es">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input type="submit" tabindex="0" class="text-0_875 s768:text-1 tracking-0_2 leading-1_5 text-left bg-white capitalize px-24 py-8 w-full border-none hover:bg-gray-f3f4f7 text-gray-65657b" lang="es" value="español">
</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="en">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input tabindex="-1" class="text-1 bg-white list-style-none my-12 capitalize tracking-0_2 leading-1_25 border-none  text-primary-3667e9 font-500" type="submit" value="English">
</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="language" value="es">
  <input type="hidden" name="next" value="/welcome/?link=576179194947">
  <input tabindex="-1" class="text-1 bg-white list-style-none my-12 capitalize tracking-0_2 leading-1_25 border-none text-gray-171731" type="submit" value="español">
</form>

POST /guest/charge/?link=576179194947

<form method="post" action="/guest/charge/?link=576179194947">
  <input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="checkout_payment_amount" value="53.82">
  <button id="pay_total_btn" type="submit" class="btn btn-primary" role="link" tabindex="0" data-test="pay_total_btn_default" data-patient-app-click="payment_clarity_pay_total_cta"> Pay total: $53.82 </button>
</form>

POST /guest/plan/?link=576179194947

<form method="post" action="/guest/plan/?link=576179194947">
  <input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <button id="payment_plan_secondary_btn" type="submit" role="link" class="btn btn-secondary" data-test="payment-plan-btn-secondary" data-patient-app-click="payment_clarity_payment_plan_cta">
    <div class="flex flex-col">
      <div> Start a payment plan </div>
      <div class="mt-8 text-0_75 text-gray-65657b"> Always 0% interest </div>
    </div>
  </button>
</form>

POST /guest/charge/?link=576179194947

<form method="POST" action="/guest/charge/?link=576179194947">
  <input type="hidden" name="csrfmiddlewaretoken" value="A4RGkTSy4eQanOcxE4JH11VoszgwQYPYNCQuwSfia45DjVstCD9sC4RyKn4FLeCS">
  <input type="hidden" name="checkout_payment_amount" value="53.82">
  <input type="hidden" value="True" name="partial">
  <button type="submit" id="pay_partial_link" role="link" class="btn-link text-primary-3667e9 focus:px-4" data-test="pay_partial_btn" data-patient-app-click="payment_clarity_partial_pay_cta"> Pay a partial amount </button>
</form>

Text Content

Please contact the # on the back of your statement in order to set up a payment
plan.

✕

skip to main content
 
Get Help
English
 * 
 * 


E
 * Log in
 * 
   My account
 * Add insurance

--------------------------------------------------------------------------------

 * Log in
 * My account
    
 * Add insurance

--------------------------------------------------------------------------------


LANGUAGES




--------------------------------------------------------------------------------

Get Help


Please contact the # on the back of your statement in order to set up a payment
plan.

✕

skip to main content
 
Get Help
English
 * 
 * 


E
 * Log in
 * 
   My account
 * Add insurance

--------------------------------------------------------------------------------

 * Log in
 * My account
    
 * Add insurance

--------------------------------------------------------------------------------


LANGUAGES




--------------------------------------------------------------------------------

Get Help



HI, EDGAR

You have one medical bill ready from Center for colorectal and pelvic health.
You can pay your bill here or verify your identity to view full bill details.
View bill details


TOTAL DUE

$53.82
Pay total: $53.82
Start a payment plan
Always 0% interest


MORE PAYMENT OPTIONS

 * Pay a partial amount

Secure payments


 * About
 * Terms
 * Privacy
 * Help Center

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