Pet Insurance Claim Form - Copy this React, Tailwind Component to your project

The form should contain following fields: Policyholder's details Policy number Policyholder's first name Policyholder's last name Policyholder's address Line 1 Line 2 Line 3 Town Postcode Contact information Contact number Email address Preferred communication channel Pet's details Pet's name Pet's date of birth Pet's type Pet's breed Microchip number Neutered Vaccinated Date of last vaccination About the claim Date of first treatment Claim description Claim category Total claim amount (if known) Supporting evidence Conditions Condition description Date first noticed Is this condition a continuation? Treatments Has this condition seen before? Illness history Treatment Treatment description Treatment start date Treatment end date Treatment quantity Treatment unit cost Illness history Date last seen Description Pet loss Has the pet died? Has the pet died as a result of the condition listed above? Select a condition that resulted in a death Date of death Was a charge made for cremation/burial? Cost Beneficiaries Beneficiary type Account name Account number Sort code Vet details Employee name