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

RtOdVSUKbOl2FGSbxFCzcMpM4eUkggTyQrQHvA6a
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content-disposition: form-data; name="customer_id"

c2f1732f-9712-40c6-8752-7ca635067089
------WebKitFormBoundarybu0477IuRMF8N8IS
content-disposition: form-data; name="date_of_injury"

12/05/2010
------WebKitFormBoundarybu0477IuRMF8N8IS
content-disposition: form-data; name="category_id"

10000
------WebKitFormBoundarybu0477IuRMF8N8IS--
