avala.com
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66.172.32.65
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Submitted URL: https://avalametairie.com/
Effective URL: https://avala.com/
Submission: On July 04 via api from US — Scanned from DE
Effective URL: https://avala.com/
Submission: On July 04 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
GET https://avala.com/
<form role="search" method="get" id="searchform" class="tf_rel tf_hide" action="https://avala.com/">
<div class="tf_icon_wrap icon-search"><svg aria-label="Search" class="tf_fa tf-ti-search" role="img">
<use href="#tf-ti-search"></use>
</svg></div>
<input type="text" name="s" id="s" title="Search" placeholder="Search" value="">
</form>POST /
<form method="post" enctype="multipart/form-data" id="gform_1" action="/" data-formid="1" novalidate="">
<div class="gform-body gform_body">
<ul id="gform_fields_1" class="gform_fields top_label form_sublabel_below description_below validation_below">
<li id="field_1_6" class="gfield gfield--type-text gf_left_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_6"><label
class="gfield_label gform-field-label" for="input_1_6">First Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_6" id="input_1_6" type="text" value="" class="large" tabindex="1" placeholder="First Name" aria-required="true" aria-invalid="false"> </div>
</li>
<li id="field_1_7" class="gfield gfield--type-text gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_7"><label
class="gfield_label gform-field-label" for="input_1_7">Last Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_7" id="input_1_7" type="text" value="" class="large" tabindex="2" placeholder="Last Name" aria-required="true" aria-invalid="false"> </div>
</li>
<li id="field_1_3" class="gfield gfield--type-phone gf_right_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_3"><label
class="gfield_label gform-field-label" for="input_1_3">Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_3" id="input_1_3" type="tel" value="" class="large" tabindex="3" placeholder="Phone" aria-required="true" aria-invalid="false"></div>
</li>
<li id="field_1_2" class="gfield gfield--type-email gf_left_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_2"><label
class="gfield_label gform-field-label" for="input_1_2">Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_2" id="input_1_2" type="email" value="" class="medium" tabindex="4" placeholder="Email" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_1_4" class="gfield gfield--type-select gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_4">
<label class="gfield_label gform-field-label" for="input_1_4">Health Insurance Provider<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_4" id="input_1_4" class="large gfield_select" tabindex="5" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">---</option>
<option value="Aetna">Aetna</option>
<option value="Benefit Management">Benefit Management</option>
<option value="Blue Cross">Blue Cross</option>
<option value="Cigna">Cigna</option>
<option value="Coventry (First Health)">Coventry (First Health)</option>
<option value="First Health / Boilermakers">First Health / Boilermakers</option>
<option value="Gilsbar">Gilsbar</option>
<option value="Humana">Humana</option>
<option value="Humana Gold">Humana Gold</option>
<option value="Legal/Attorney">Legal/Attorney</option>
<option value="Medicaid">Medicaid</option>
<option value="Medicare">Medicare</option>
<option value="Office of Group Benefits (OGB) (Blue Cross)">Office of Group Benefits (OGB) (Blue Cross)</option>
<option value="People's Health">People's Health</option>
<option value="PPO Plus">PPO Plus</option>
<option value="State Group (Blue Cross)">State Group (Blue Cross)</option>
<option value="Tricare">Tricare</option>
<option value="United Health Care (UHC)">United Health Care (UHC)</option>
<option value="Vantage Health">Vantage Health</option>
<option value="Wellcare">Wellcare</option>
<option value="Worker's Comp">Worker's Comp</option>
<option value="Other">Other</option>
</select></div>
</li>
<li id="field_1_5" class="gfield gfield--type-select gf_right_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_5"><label
class="gfield_label gform-field-label" for="input_1_5">How did you hear about AVALA?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_5" id="input_1_5" class="large gfield_select" tabindex="6" aria-required="true" aria-invalid="false">
<option value="" selected="selected" class="gf_placeholder">---</option>
<option value="Billboard">Billboard</option>
<option value="Commercial">Commercial</option>
<option value="Email">Email</option>
<option value="Family/Friend">Family/Friend</option>
<option value="Flyer">Flyer</option>
<option value="Google">Google</option>
<option value="Legal">Legal</option>
<option value="Magazine">Magazine</option>
<option value="Newspaper">Newspaper</option>
<option value="Physician">Physician</option>
<option value="Previous Patient">Previous Patient</option>
<option value="Radio">Radio</option>
<option value="Seminar">Seminar</option>
<option value="Social Media">Social Media</option>
<option value="Workers Comp">Workers Comp</option>
</select></div>
</li>
<li id="field_1_8" class="gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_1_8"><label
class="gfield_label gform-field-label" for="input_1_8">Name</label>
<div class="ginput_container"><input name="input_8" id="input_1_8" type="text" value="" autocomplete="new-password"></div>
<div class="gfield_description" id="gfield_description_1_8">This field is for validation purposes and should be left unchanged.</div>
</li>
</ul>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_1" class="gform_button button" value="Submit" tabindex="7"
onclick="if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_1" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="1">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_1" value="WyJbXSIsIjk2NmIxZDlhNWI5MzA2NDRiOWU3NTdhYjhiOWEwOWU1Il0=">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_1" id="gform_target_page_number_1" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_1" id="gform_source_page_number_1" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
<p style="display: none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_1" name="ak_js"
value="1720107139724">
<script>
document.getElementById("ak_js_1").setAttribute("value", (new Date()).getTime());
</script>
</p>
<div id="altEmail_container" class="altEmail_container"><label for="alt_s">Alternative:</label><input type="text" id="alt_s" name="alt_s"></div><span class="wpa_hidden_field" style="display:none;height:0;width:0;"><label>WPA <input type="text"
name="buvdrz318" value="592952"></label></span>
</form>Text Content
Skip to content Menu Trust Healthcare Again Search * About * Health * Physicians * Robotics * Imaging * Therapy * 985.809.9888 * . Close Menu TRUST HEALTHCARE AGAIN Request Appointment ROBOTICS Learn More HOSPITAL Learn More THERAPY Learn More IMAGING Learn More REQUEST APPOINTMENT * First Name* * Last Name* * Phone* * Email* * Health Insurance Provider* ---AetnaBenefit ManagementBlue CrossCignaCoventry (First Health)First Health / BoilermakersGilsbarHumanaHumana GoldLegal/AttorneyMedicaidMedicareOffice of Group Benefits (OGB) (Blue Cross)People's HealthPPO PlusState Group (Blue Cross)TricareUnited Health Care (UHC)Vantage HealthWellcareWorker's CompOther * How did you hear about AVALA?* ---BillboardCommercialEmailFamily/FriendFlyerGoogleLegalMagazineNewspaperPhysicianPrevious PatientRadioSeminarSocial MediaWorkers Comp * Name This field is for validation purposes and should be left unchanged. Δ Alternative: WPA Contact Us Patient Portal Pay my Bill NAVIGATION * About * Culture * Health * Physicians * Robotics * Imaging * Therapy * Events * News SERVICES * Spine & Robotic Surgery * Orthopedic & Robotic Surgery * Pain Management * Neurosurgery * Ophthalmology * General Surgery * Gastroenterology * Colon-Rectal Surgery * Plastic & Reconstructive Surgery IMPORTANT LINKS * AVALA Surgery Center * Blue Distinction Center+ * Center of Excellence * FAQs * Insurance * Nondiscrimination * Privacy Practices * Visitors Guide * Disclosure of Physician Interest * Patient Amenities CONTACT 67252 Industry Lane Covington, LA 70433 (985) 809-9888 * * * * © AVALA 2024 PHYSICIAN LED. PHYSICIAN OWNED. * Employee Portal * Careers * News * Online Privacy * Accreditation Google Recaptcha Notifications