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

y7YvjRCxAaOEjpjQHcQUIAKPAEg5umPOB0rYqCUY
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content-disposition: form-data; name="customer_id"

dfbf6577-34ad-4135-8bc3-5d945cc21108
------WebKitFormBoundarygzuVZEWFwt0GvjKZ
content-disposition: form-data; name="date_of_injury"

04/09/2005
------WebKitFormBoundarygzuVZEWFwt0GvjKZ
content-disposition: form-data; name="category_id"

10000
------WebKitFormBoundarygzuVZEWFwt0GvjKZ--
