------WebKitFormBoundary8TBvcreKIwF10Snc
content-disposition: form-data; name="_token"

MAwn8MjKQ0OKlToL61KhW6HpOBksyh4V9YKBrL28
------WebKitFormBoundary8TBvcreKIwF10Snc
content-disposition: form-data; name="customer_id"

8eadc9de-ce25-4748-a656-97fca67d2451
------WebKitFormBoundary8TBvcreKIwF10Snc
content-disposition: form-data; name="date_of_injury"

12/05/2010
------WebKitFormBoundary8TBvcreKIwF10Snc
content-disposition: form-data; name="category_id"

10000
------WebKitFormBoundary8TBvcreKIwF10Snc--
