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content-disposition: form-data; name="_token"

Bq6C06tUq7VyWUXHqCjS9t9c0MacBgbFziy8fDqY
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content-disposition: form-data; name="customer_id"

8ef668d9-c416-49ab-9fd3-fc9b539528f4
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content-disposition: form-data; name="date_of_injury"

04/09/2005
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content-disposition: form-data; name="category_id"

10000
------WebKitFormBoundaryajQ53lKTLgDPKJdW--
